“I need a break,” I said to my doctor after finally recovering from the flu and pneumonia that had made my life miserable for 6 weeks straight.

“I agree,” my doctor responded. “I’m writing you a prescription. For a vacation. Doctor’s orders.”

My face brightened – now this was a medication I could get behind.

“Any idea where you want to go?” my doctor asked. 

I had in fact been making plans, even while sick, and had put together an exotic itinerary.

“Vietnam,” I replied. Along with Cambodia and Laos, Vietnam had long been at the top of my personal travel bucket list. Plus, our youngest son had just been there as part of his post-army trek last year.

Halong Bay, Vietnam

“Oh,” my doctor said quietly, and her face dropped.

I had expected this reaction: cancer patients with compromised immune systems, especially those getting just over pneumonia, probably shouldn’t travel to countries not so rigorous about high standards of hygiene.

This conversation took place a week before the Wuhan, China-based coronavirus now known as COVID-19 began dominating headlines. And then our travel plans necessarily changed. 

One after another, airlines began canceling routes to and from mainland China. Countries sealed borders. Face masks sold out.

Vietnam declared a public health emergency and banned flights from its northern neighbor – including from Hong Kong, which was how we were planning to fly to Hanoi. (Hong Kong flights have since been reinstated, but by the time this is published, that could be reversed again.)

This is not the first time that we’ve had to change plans due to a virus in Asia. In 2002, my wife, Jody, and I were planning a vacation to China just as the SARS epidemic hit. When El Al suspended its flights to Beijing, we opted for India instead. 

With Southeast Asia out – for now at least – Jody and I began reviewing the rest of our travel bucket list. When the time is right again, where else could we go – preferably far from the epicenter of this current outbreak?

Bucket lists are more than a pleasant distraction: they have real psychological value. Fulfilling a bucket list “is an attempt to make life memorable and is consistent with [Israeli Nobel Prize Winner] Daniel Kahneman’s peak-end theory,” which holds that what people retain most from events and experiences are their peaks, writes Prof. Christopher Peterson in Psychology Today. “Bucket lists, if accomplished, set memories in place that structure life as remembered.” 

Bucket lists can have a downside, as well. Writing in The New Yorker, Rebecca Mead called bucket lists “a commodification of cultural experience, in which every expedition made, and every artwork encountered, is reduced to an item on a checklist to be got through, rather than being worthy of repeated or extended engagement.”

While it’s true that I rarely go back to a place I’ve already visited (just as I hate watching movies twice), curating a travel bucket list can give you something to look forward to, especially when you’re feeling down. It helps prioritize limited vacation time, too. 

Travel bucket lists can become a bit morbid when, like me, you actually have a serious illness and the bucket, while not in any danger of being kicked in the immediate future, feels slightly more real than metaphorical.

Jody and I have traveled a lot, both with and without the kids, since we moved to Israel: the pyramids in Egypt, safari in Tanzania, 11 days on the Annapurna Trail in Nepal. We’ve journeyed up and down Israel, on foot, by bus and in cars, in our 25 years here.

For our 30th wedding anniversary, we planned to hike into Machu Picchu in Peru. But that was the year of my chemo and a 4-day intensive trek on the Inca Trail at high altitude was out. South America remains near the top of our travel bucket list.

Also on our list (in no particular order):

Iceland – volcanos, the Blue Lagoon geothermal spa, caving and waterfalls galore. (If only it wasn’t so cold, but that’s why it’s called Iceland.)

Morocco – a Muslim country with a rich Jewish past that isn’t overly anti-Zionist. 

Alaska – hiking through the 6-million-acre Denali National Park, gazing at glaciers while avoiding any run-ins with grizzlies, would be an outdoorsy dream.

South Africa – a week-long drive along the Garden Route southeast of Cape Town sounds as romantic as the Far East is exotic. 

Japan – I’ve already visited three times (twice for work) but Jody’s never been. Plus, it’s been years since I had authentic okonomiyaki.

Croatia and Slovenia – the former because Game of Thrones; the latter for a less expensive version of the Alps. (Substitute Georgia or Bulgaria for equally exquisite trekking close to Israel.)

Budapest – time it right and Wizz Air can get you from Israel to one of Europe’s most beautiful capitals for under $200 round-trip.

India – we’ve done the Delhi-centric tourist triangle along with a weekend in Mumbai, but the south still beckons. 

Russia – to tour this world power would be fascinating, but are Israelis welcome there anymore? Even without weed in our suitcase?

It’s fun to fantasize, but with the world in the grips of a possible pandemic, the safest thing to do is probably to hunker down at home and watch travel shows on TV. (I’m pretty sure my doctor would agree.)

When the COVID-19 danger eventually passes, though, there’s one more place I’d hate to miss: China. 

So, what’s on your travel bucket list?

I originally put together my travel bucket list for The Jerusalem Post.

Image of Halong Bay from Thomas Hirsch.

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Foiled by the flu

by Brian on February 1, 2020

in Cancer,Health

It was the flu that finally broke me.

The past two years have not been easy, to say the least: chronic stomach pains leading to a diagnosis of cancer, followed by a year and a half of treatments, a relapse, and then the need for cataract surgery, the latter a probable complication of chemo. 

I coped with each as best I could, trying to spin adversity into life lessons. I got sad sometimes, to be sure, but remained stoic for the most part. 

That was until the flu felled me. 

This winter’s strain has been particularly virulent (and that’s not even considering the new coronavirus raging in China). I’ve never gotten the flu shot – not because I’m opposed to vaccines but because my immune system has always been strong. Even last year, when I was in the midst of cancer treatment, I didn’t catch a bug. So, despite our HMO sending out repeated reminders, I dithered. 

Until it was too late.

“Everyone feels like they’re dying when they have the flu,” my son, Amir, reassured me as I was massaging my sinuses in a vain attempt to reduce some of the pressure. 

I nodded weakly. But inside, I was panicking. 

Was this it – the virus that finally sends me to the hospital like so many of my fellow follicular lymphoma voyagers? Maybe my compromised immune system won’t be able to fight this one off on its own. Should I have been wearing a mask when I went out in public? 

The flu was my cherry on top of an already unpalatable series of unfortunate events. The most recent: cataracts gone wrong.

When I found out I’d need eye surgery, I was actually looking forward. If it worked properly, I’d be able to see without glasses for the first time in 52 years!

But the process of swapping out the clouded lens in one eye for a clear new artificial one loosened some flecks of collagen that began bobbing across my field of vision in the gel-like fluid of the eye called the vitreous. 

You may have experienced this, too: most people will develop so-called “floaters” as they age, although cataract surgery ups your chances.

Floaters don’t indicate anything is medically wrong, but they can be maddening – like a swarm of flies buzzing in front of you except you can’t swat them away because they’re literally in your eyes

And there’s not much you can do, my ophthalmologist explained, other than wait to see if they “settle” out of sight or if the brain “neuro-adapts” so they don’t bother you so much. 

In the meantime, I could barely work. I said no to meet ups with friends because I was so distracted. About the only time the floaters didn’t bother me was while watching TV when, for some reason, they would move off to the side.

I’ve been watching a lot of TV.

I never felt disabled the entire time I was going through chemo. I had various aches and pains and fatigue, but I was still able to haul myself in front of my computer and write. I never imagined, as a result of cancer, I would become visually impaired. 

Combine that with the fact that, with my cancer no longer in remission, I’ll have no choice but to restart treatments at some point, add in the misery of the flu, and I finally felt defeated by my body.

And for one of the only times in this somber saga, I broke down and sobbed. 

My wife Jody was there to contain me. She stayed silent for a long time, holding my shaking body. 

“What are you scared of?” she asked eventually.

The answer surprised me. 

“I’m scared that I’ll become like my father,” I replied.

My father contracted polio as a teenager. He recovered and was able to walk with barely a limp until he was later beset by “post-polio syndrome.” Eventually, he required a wheelchair to get around. 

My father was no stranger to kvetching, but I never heard him complain about the hand he was dealt regarding the polio. Still, I could imagine the conversations that must have taken place behind closed doors between him and my mother. I surmised how my mother resented having to become his caretaker. I didn’t want that for Jody. 

“You’ve got cancer, floaters and the flu,” Jody comforted me. “You’re far from disabled.”

“But I don’t know what’s coming next,” I bemoaned.

“Then I’ll take care of you,” Jody said. “Will you let me take care of you?”

What could I say? That you didn’t sign up for this, Jody? But she did – it’s one of the vows we took when we got married. (OK, we didn’t actually recite vows at our chuppah, but it was implied.) 

Now Jody was asking – pleading with me – to not go through this alone. 

I nodded reluctantly for the second time that day. 

The flu turned out to be not just the flu but pneumonia. It took another two weeks and antibiotics, but it finally passed, and I never went to the hospital. 

The floaters are still with me, but there’s a laser treatment I’ve been reading about that’s supposed to have good results. As for the cancer treatments – they’re still coming, I just don’t know when.

I reached a low point with the flu. But I also forged a renewed understanding with my wife – and maybe an added appreciation for what my parents silently suffered through.

This may not be what we signed up for – but it’s what we’ve got. The alternative is unquestionably worse.

The flu originally foiled me at The Jerusalem Post.

Coronavirus image from National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH).

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One-eyed bowling

by Brian on January 19, 2020

in Cancer,Health,Science

I’ve never been a great bowler. Now try doing it with only one eye. 

Jody bowls a strike at the bowling birthday party

That’s the situation I found myself in when my wife, Jody, and I were invited to a bowling party to celebrate a good friend’s birthday. 

It was a few days after I underwent cataract eye surgery. In addition to removing my cloudy cataract lens, the operation would have the added benefit of giving me near-perfect vision.

However, unlike LASIK, where both eyes are done on the same day, ophthalmologists generally operate on only one eye at a time for cataracts, with a two-week break between surgeries.

That meant that for a fortnight, my left eye would be able to see distance perfectly, but my right eye would be its old myopic self. 

The result was “clear” the night of the party: the pins at the end of the bowling lane were a blurry mess. Not surprisingly, my bowling form consisted primarily of aim, release … and gutter ball. By the evening’s end, I had the lowest score of the group (although admittedly I had the most creative excuse).

I never had a problem with cataracts until I started chemo for my chronic cancer two years ago. The steroids that are part of many cancer-killing regimes are known to exacerbate cataracts. Cataracts are also a natural part of getting older: by age 65, 90% of adults will have a cataract of some sort.

While I wasn’t particularly worried about the surgery going awry, it was nevertheless distressing on a conceptual level – an unavoidable symbol of my body’s overall decline. 

When I was younger, a cold or a flu would last maybe a couple of weeks. There would then be a long period of health, followed one day by another illness. It was no fun to get sick, but I knew it would most likely be temporary.

Not so much anymore. 

When I get a new ache or pain, I can no longer be sure that it will eventually go away on its own. I wasn’t able to just get a new prescription for glasses this time – I needed surgery. As for my incurable chronic cancer, it will, by definition, be with me for life.

My therapist suggested I read Judith Viorst’s Necessary Losses: The Loves, Illusions, Dependencies and Impossible Expectations That All of Us Have to Give Up in Order to Grow. In the book, Viorst – a columnist for Redbook who spent six years training at the Washington Psychoanalytic Institute – argues that losses are an inescapable part of life and are, in fact, the way we grow and change.

Put another way, for every growth, there is a necessary loss.

It happens at every age, consciously and unconsciously, Viorst writes. 

We lose our mother’s protection and connection. 

We must give up the impossible expectations we bring to relationships – friendships and marriages alike. 

We lose our youth and eventually our loved ones through separation or death. 

But by confronting – and eventually accepting – these losses, we also gain maturity and wisdom. Losing is the price we pay for living, Viorst says.

Viorst’s thesis is comforting, but it’s not an easy pill to swallow. That may be due to our natural “negativity bias,” an evolutionary necessity that ensured we stayed hyper-alert to potential predators in the savannah.

“Bad events and emotions affect us more strongly than positive ones,” write John Tierney and Roy Baumeister in their new book The Power of Bad: How the Negativity Effect Rules Us and How We Can Rule It“We’re devastated by a word of criticism but unmoved by a shower of praise. We focus so much on bad news, especially in a digital world that magnifies its power, that we don’t realize how much better life is becoming for people around the world.”

Tierney and Baumeister describe how a negative image (a photograph of a dead animal) stimulates more electrical activity in the brain than a positive image (a bowl of chocolate ice cream) and how “a single bad event can produce lifelong trauma but there is no psychological term for the opposite of trauma because no good event has such a lasting impact.”

The negativity bias can be overcome but it takes work. In an article in The Wall Street Journal, Tierney and Baumeister propose a number of techniques. One of them is the rule of four. “A negative event or emotion usually has at least three times the impact of a comparable positive one.” As a result, “it takes four good things to overcome one bad thing.” 

For example, you’ll need at least four compliments to make up for one bit of criticism. “If you’re late for one meeting, you won’t redeem yourself by [simply] being early the next time,” they write. 

Good managers have known about this for a while. They call it the “compliment sandwich.” You start with a word or two of praise before giving some criticism. You then follow it up with another compliment or two. 

Then there’s this helpful personal tip: “If you and your partner are having sex four times more often than you fight, that’s probably a healthy relationship.”

Most of all, “see the big picture,” Tierney and Baumeister write. “Crime has plummeted in the U.S., but most Americans think it has risen because they see so much mayhem on their screens.”

I’m certainly no stranger to mayhem – in my body, that is. But the big picture is I’m still here. And I’m still bowling – as of this writing with two post-surgery (although far from perfect) eyes. 

I suppose I’ll stick around for a while, despite all the necessary losses. There’s still at least four times as much good as there is bad out there to see.

I first went one-eyed bowling for The Jerusalem Post.

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“Get out.” That was the provocative headline of a 2019 article by Liel Leibovitz that appeared in Tablet Magazine. Leibovitz was responding to the increasingly hostile environment for Jewish students on American university campuses, especially those who are pro-Israel.

Citing examples of what he called “active discrimination against Jewish students” at Williams College (where the student-run College Council denied the request of a new pro-Israel student group to be recognized) and NYU (where the anti-Zionist Students for Justice in Palestine won the school’s prestigious Presidential Service Award), Leibovitz argues that “even the finest American universities [have evolved] into hotbeds of dogmatic identity politics” which makes them “increasingly inhospitable to Jews and to Jewishness.”

Leibovitz concludes: “If you’re a young Jew who is thinking about tagging your parents with the bill for a famous college or university, don’t bother.” 

Leibovitz makes a compelling case, but the truth is, I have no direct insight into what’s really happening on American campuses today. 

So, I turned to someone who might know more: another Liel – last name Zahavi-Asa – who worked as the director of Jewish life and Israel engagement for Rutgers Hillel from 2015 until last year when she returned to Israel where she grew up.

I’ve followed Zahavi-Asa’s journey literally since she was born: her parents were in Berkeley when my wife, Jody, and I lived there too. We made aliyah a few years before they did and have stayed good friends.

Zahavi-Asa says, based on her experience organizing Jewish and pro-Israel events on campus, that Leibovitz’s prescription would be nothing short of disaster. 

“If all the Jewish students pulled out, those campuses would become even bigger centers of anti-Israel sentiment than what they’re already starting to become,” she says. 

You could say the same thing about Israel and the Middle East, she adds, “that it’s not worth investing money if there’s a chance you could get killed. But sometimes you have to stand on your own two feet and fight for what you believe in.” 

Zahavi-Asa does have a beef, however, with the way many Jewish and Israeli organizations go about that fighting. She is especially critical of groups that “parachute” into a campus and start screaming from a soapbox. 

“Students don’t want to be yelled at,” she says. Moreover, these external organizations “aren’t working in tandem with the staff on campus. They don’t know the campus climate about Israel. They’re only around for one or two days. And so they often end up doing more harm than good.”

What should Israel advocacy groups do instead? “Work with the Hillel staff,” she says. Or the local Chabad rabbis or Israel Fellows. “We’re on campus 24/7. We are the ones that have to deal with everything that happens, the good and the bad.”

Zahavi-Asa points to the Maccabee Task Force as an organization that works closely with Jewish student leaders and staff. Created in 2015, the organization has funded more than 1,600 pro-Israel events and is active on 80 campuses in the U.S. and Canada. While the Task Force is not shy about providing suggestions for activities, ultimately, they let their local campus partners decide what to do with the funding they give, Zahavi-Asa says.

Jewish support for Israel on campus is malleable and changes over time, Zahavi-Asa adds. Students fresh out of Zionist Jewish day schools, or who are returning from a gap year in Israel, come to college ready to fight. “They immediately join or start an Israel club. But by their junior or senior years, a switch takes place.” 

It’s not that they become less passionate about Israel. “But they are exposed to aspects about world history they might not have studied in their Jewish day schools,” Zahavi-Asa notes. “They also meet immigrants from many other places. They start to see that not everything revolves around Israel. Israel becomes a piece of a bigger puzzle.”

This nuanced view may turn out to be the best result of the college experience – and the reason Leibovitz’s admonishment to “get out” is so ill-advised in the eyes of the other Liel. Sticking around allows mature Jewish students to build their own intersectional groups. 

“They can develop greater authenticity in their pro-Israel activism,” Zahavi-Asa says. “It’s a more effective way of creating ‘allyship’ than the pro-Israel advocacy groups which push students into battle mode.” 

Visiting Israel can help. But not via the standard Birthright trip. A better approach, Zahavi-Asa says, are mixed groups of Jewish and non-Jewish student leaders. 

“These groups go to Jerusalem and Tel Aviv, but they also go to the West Bank,” she explains. “They get a realistic idea of what Israel is about by exploring it together. They may still disagree, but it creates the opportunity for a more honest discourse.” 

“A trip to Israel is an extraordinarily effective tool to get critics to pay attention to Israel long enough to understand that the narrative they’ve been fed just isn’t true,” says David Brog, the executive director of the Maccabee Task Force, which sponsors these types of trips. “Even a bad trip to Israel is effective because the gap between the myths and the reality is so very wide.”

Zahavi-Asa is now back in Israel where she works for the post-Birthright “Onward Israel” program as well as gap-year provider Aardvark Israel. She is also taking the Israeli tour guide course “to better explain to others what the Jewish connection is to this land,” she says.

Her tenure making Israel’s case on American Jewish campuses is clearly not over.

I first wrote about Liel Zahavi-Asa in The Jerusalem Post.

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Good news, bad news or no news?

by Brian on December 22, 2019

in Cancer,Science

Are you a “good news first” or a “bad news first” type of person? Or maybe you prefer no news at all? That’s where I found myself following my second bone marrow biopsy in as many months: avoiding contacting my doctor in case the results were not what I wanted to hear.

It was a very different kind of response for me. 

I was all over my first biopsy – the initial one from two years ago, when I was first diagnosed with chronic cancer. I was equally on top of the pathology results from my biopsy in September, which confirmed what the PET CT had shown: that this was not a benign growth (the best though least likely scenario) but a return of my lymphoma. 

I went under the needle one more time to check my bone marrow. Good news: no cancer there. But there was still something off that didn’t make sense to my doctor; she ordered a second biopsy. 

Those were the results I was waiting for now. I should have heard after about 10 days. But I didn’t and, remarkably, I seemed to be happier that way. 

Avoiding news like this goes against how philosophers and scientists have long understood the way human beings process information. 

The idea that individuals seek – or at least pay attention to – sources of information is “deeply embedded in Western culture, at least as far back as Aristotle’s statement that ‘all men, by nature, desire to know,’” writes library and information science professor Donald O. Case in a 2005 paper published in the Journal of the Medical Library Association.

Yet, as psychologist Abraham Maslow (famous for his “hierarchy of needs”) noted in 1963, “we can seek knowledge in order to reduce anxiety and we can also avoid knowing in order to reduce anxiety.”

Herbert Hyman and Paul Sheatsley have described the latter as “selective exposure.” That’s where human beings so desire cognitive consistency that they will avoid reading or hearing about information that conflicts with their internal states.

That, of course, aptly describes our modern media environment. In my case, though, it’s more that I desperately want to believe I’m still healthy, that I won’t need more treatment at some point in the future, that this will all somehow just “go away.” Avoiding any news that might contradict that perception serves me in its own perverse way.

“Avoidance is a simple way of coping by not having to cope,” therapist and journalist Lori Gottlieb points out in her best-selling book Maybe You Should Talk to Someone.

People also opt out of information-gathering when they feel powerless, adds Israeli-born sociologist Elihu Katz. It doesn’t make a lot of sense to delve deep into things over which one has no control.

It gets even trickier when it comes to cancers like mine that wax and wane but always return, and where there’s no clear line between “remission” and “relapse.” 

Indeed, some doctors have stopped using those terms. The cancer is always there; it’s just that, for certain periods, the chemo pulverizes it so that the scans can’t find any tumors and your status becomes NED (short for “no evidence of disease”). 

In this respect, I never really relapsed. I’ve just gone “non-NED” for a while and I’ll probably do it again another few times over the course of my life.

So, could living in denial actually be an effective strategy for contending with chronic cancer?

Not really. Science seems to support the opposite: embracing bad news rather than resisting it. Researchers from the University of Toronto and UC Berkeley have dubbed this “habitual acceptance” and they write that it “helps keep individuals from reacting to – and thus exacerbating – their negative mental experiences.”

Dr. Moshe Shay Ben-Haim at Tel Aviv University has proposed a technique involving repeated exposure to a negative event in order to assist people grappling with bad news.

“We show that, counterintuitively, you can avoid getting into a bad mood in the first place by dwelling on a negative event,” Ben-Haim writes. “If you look at the newspaper before you go to work and see a headline about a bombing or tragedy of some kind, it’s better to read the article all the way through and repeatedly expose yourself to the negative information. You will be freer to go on with your day in a better mood.”

Will finding out my bone marrow biopsy results allow me to be happier in the long run? Or will it plunge me into even more uncertainty over which I remain powerless? 

Uncertainty “doesn’t mean the loss of hope – it means there’s possibility,” writes Gottlieb in her book. “I don’t know what will happen next – how potentially exciting. I’m going to have to figure out how to make the most of the life I have, illness or not.”

After a full month had passed with no news from my doctor, I finally mustered up the courage to welcome uncertainty and embrace any bad news. I fired off a WhatsApp. 

My doctor replied quickly. The second bone marrow sample looked better than the first, she wrote, “with more functioning blood cells than were seen initially” although the percentage was still much lower than normal. Then again, I have cancer, I reminded myself, so what did I expect?

I didn’t comment on how I hadn’t been in touch, nor did I ask my doctor why she hadn’t updated me as soon as she received the results. Maybe she’s a no news sort of person, too. 

Although I’m not so sure I am anymore.

I first wrote about how I deal with good and bad news at The Jerusalem Post. Image from Damian Gadal – She’s bad news, CC BY 2.0

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“You’re not sick enough”

December 8, 2019

“You’re not sick enough to write about your health,” my friend said. “No one will take you seriously unless you’re close to death.” Was he right? An article about health and impostor syndrome.

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Did climate change kill the Jacob’s Ladder music festival?

November 23, 2019

If there was one thing you could always count on, it was that the weather at the Sea of Galilee in May, would be rain-free. Not so anymore.

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Why I can no longer daven in an Orthodox synagogue

November 9, 2019

Here’s why I no longer daven in mechitzah minyans: It’s a symbol signaling that separate roles for men and women are immutable and eternal. I say no!

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Running simulations

October 26, 2019

Dwelling on worst-case scenarios can be crazy making. But spinning simulations is also essential to being human, says Prof. Moshe Bar.

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Twenty-five reasons to live in Israel

October 13, 2019

Last week marked our “aliyah-versary.” Twenty-five years ago, on October 10, 1994, my wife, Jody, and our two young children immigrated to Jerusalem from Berkeley, Calif. A third child – our only Sabra – was born a few years later. So, on this, the silver anniversary of our Israeli citizenship, I present 25 reasons to […]

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