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Reflections from the Precipice

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On Climbing the COVID Mountain: A Heartfelt and Fact-Based Plea by an Emergency Room Doctor

By Dr. Evan Cohen

As an emergency physician, a husband and a father of two young children, I spend a lot of time thinking about Covid. Where we have been and where we are going. I find that despite all the destruction and pain that we have endured, the future is still ours to create.

Here, on the precipice of the Covid mountain I realize that I’ve gone through all of the stages of pandemic grief. In February and early March it was shock and disbelief. I did not think that Covid-19 would be so bad; it was being overblown by the media. Like Ebola, Bird Flu and SARS, it was happening far away and would not affect me. When it reached our shores and my community in New York, I felt certain that we could briefly quarantine our way out of the mess. As April rolled around, I was angry that so many people were dying. Selfishly, I was even more angry about the sacrifices that my family and I had to make. No more weekend date nights or get-togethers with friends, no vacations, no school or playdates for my children and there were no more escapes to the arcades and indoor playgrounds on those painful rainy days.  

Dr. Evan Cohen and his family

I stopped at the guilt stage during a frightening two weeks when my parents developed Covid. My father recovered very quickly, but as my mother’s illness lingered, I kept seeing her face superimposed onto my patients in the emergency department. I was constantly thinking about the possibility of someone so important to me lying in a hospital bed alone and with no effective treatments available. The worst part as a son and emergency doctor was that there was nothing that I could do other than call her every few hours to make sure her breathing wasn’t labored. After that experience, the Covid-related depression was almost a relief. It didn’t matter much that I am trained to recognize the risk factors for depression and get people help when they need it. I could only feel positive for so long while thinking about all that had been taken away from me, there was no end in sight. I remember leaving an interview I gave on Covid-related depression and feeling so hypocritical telling people how to try and battle the same gloom that I was feeling.

What kept me going during that time was the incredible support that I and my colleagues received from our community. As an ER doctor, I feel like I’ve been trained to deal with anything and anybody that comes through my doors. Having trained in Camden, New Jersey and worked all over the east coast of this country, nothing could shake or surprise me and I was proud of that. Many times, I was so good at separating emotion from reality that I forgot the value of my work. As a heartfelt reminder, our staff received countless letters of gratitude and witnessed several “drive-by” parades organized by the community. The hospital played “Fight Song” on the loudspeaker every time a Covid patient was discharged, a moment that always sent a shiver down my spine! I pray that every health care worker felt as appreciated as I did during those months.    

The summer offered me a much needed respite and life almost felt normal. My mood was tied to the case count and as cases trended down in my community, I was able to spend time with my extended family, take my children to the playground and pool club. I would go days at a time without seeing a Covid patient at work.  Now, with the summer in the rear view mirror and the weather getting too cold to play outside, I’ve reached the acceptance phase, although I’ve had to go through many of these painful phases again on my way here.  

I accept that Covid is real and won’t disappear if we just wish hard enough. I accept that many more people will get sick and die and I accept that there will be sacrifices this winter. I also accept that myself contracting Covid is not inevitable and that I have some control over how things work out.  

Nationwide, we are seeing the exponential spread of this illness come back with a vengeance.  As case counts reach a critical level, the internal calculus we have been doing has changed.  Chances are that any time there is any gathering of more than just a few people, there will be someone in the crowd with Covid. We are back to all Covid all the time. The biggest public health threat, hospital overcrowding, is happening again.  

I appreciate that it seems like fewer people are dying and going on ventilators compared to last spring. The best explanation I can come up with for this is complex but I think is partially related to the amazing work of the scientific community in narrowing down and creating effective therapeutics. Dedicated scientists were able to figure out in short order that hydroxychloroquine, early ventilator use and azithromycin were out and remdesivir, steroids, and blood thinners were in. I feel optimistic about the new arrival of monoclonal antibodies. Despite all of these drugs, the most important factor that I see is the availability of nurses and other health care workers to be adequately staffed to care for the large numbers of Covid patients in the hospitals. This just cannot be overstated for any medical condition that requires a high intensity of care! For anyone that has recovered from surgery or serious illness, you know how important it is to take your medications on time, eat nutritious foods, be clean, communicate with loved ones and be able to walk. One of my health care heroes, a nurse colleague, donated countless hours last spring cleaning soiled patients and feeding them. those being the most essential tools in her toolkit. Those simple but crucial things just can’t happen without adequate staffing in hospitals.  

Now, from standing on what I hope is the precipice, I see two futures. In one dark world, we have not learned from the mistakes of the past. Our Ids control our superego and we do what feels good. After all, it feels good to eat in a restaurant, to hang out with our friends, and to see our families. In this future, I see our schools closing down and my five-year-old son unable to sit still for Zoom kindergarten. I see my three-year-old daughter deprived of seeing her best friend and unable to get the amazing nurturing experience and growth she has been given this year at her nursery school. I see the death tolls rolling up. I see my colleagues in medicine going back into that dark place of last spring. In the other (brighter) future, I see us all banding back together the way we did in April. We can be supportive of each other during this time and simply do better at keeping the virus at bay.  I do not accept that we have given our best effort at controlling this pandemic.    

I believe that to act with conviction, you must first understand your WHY. My WHY with Covid is mainly driven by fear. I have a fear of my friends and family getting sick, of my children not being able to go to school, overcrowded hospitals and of coming down with a debilitating case of Covid just days before I was scheduled to receive the vaccine. I will never claim that my Covid behavior is perfect, but any sacrifices that I make are with those visions in mind. I know that everyone has different motivations in their lives; nevertheless I hope and believe that many of our WHYs are aligned.  

Whatever your goals and motivations, we have a path forward in this together. And, thanks to the knowledge we have now in terms of mask wearing and physical distancing, we can do better. On the other side of this peak will be hundreds of millions of miraculous life-saving vaccines. Out of this tragedy, it’s possible that the Covid vaccines will offer the most impactful gift that the house of medicine has ever given to humanity. 

As the winter rolls in and we get an influx of young adults home from college and a line-up of holidays that traditionally foster large gatherings, all that I ask is for all of us to realize what is at stake and how close we are to being on the other side of this mountain. I hope to see all of you when we get there.

Dr. Evan Cohen is originally from Rockland County, New York and obtained a B.S degree from Syracuse University. He obtained his medical degree from SUNY Upstate Medical University in Syracuse New York and completed an emergency medicine residency at Cooper University Hospital in Camden New Jersey. Currently, he is serving as a medical director and practicing emergency physician in Orange County New York. He lives with his wife and two children in Chappaqua, New York.

 

A Search for Joy in ‘Something New’

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Contemplating the Holidays Without My Extended Family

One of my brothers-in-law recently noted that the lack of family gatherings over the last seven months has thrown off his internal calendar. We have a large extended family–and it’s the celebrations and gatherings with those relatives that help mark the passage of time and distinguish one week, one month, one season from another.

If ever there was a time that we could benefit from the rhythm and joy of family gatherings, it’s now. And yet, if ever there was a time that we could benefit from staying away from each other, it’s now.

In past years: The author’s extended family at Christmas

So, what to do with the holidays? In normal years, we would host anywhere from 20 to 30-something on Thanksgiving and Christmas Eve. Our mid-century modern house isn’t huge, but its open floor plan allows everyone to be together in the same space whether cooking or engrossed in conversation. On Thanksgiving, we drag extra tables and chairs up from the garage, and each individual family contributes dishes and their labor to the effort. On Christmas, the base of the tree is smothered in gifts we exchange through Secret Santa and a hilarious Yankee Swap. I love watching the cousins of my children’s generation curl up together on our wraparound sofa like one long genetic sequence.

We are lucky: there is no embarrassing drunk uncle disrupting dinner. I am lucky: I never feel burdened by the toll of the work because there are so many hands offering help. If it sounds nauseatingly civilized, I suppose it is. I embrace the winter holidays with a passion that would provoke eye rolling among cynics, an association to which I belong the other ten months of the year.

This year with the pandemic still raging and travel fraught with peril, some of our family members are spread far enough away that they might as well live on another planet. My daughter, who just graduated from college in May, will be spending Thanksgiving in Alaska where she currently lives, returning for a week or two at Christmas. My son, a sophomore in college, is not allowed to come home for Thanksgiving unless he stays here through Christmas and winter break. So, we will be empty nesters for the first time ever at Thanksgiving. My sister recently moved to Green Bay, Wisconsin, to be with her daughter. I have two sisters-in-law who, with their families, live flights away, one in Europe. They haven’t seen any of their siblings (there are seven) or their ninety-three-year-old dad in nearly a year.

We’ve had a few conversations about the possibility of mini gatherings of six-ten. We’ve also considered the question, could Thanksgiving be held outdoors? We bought a restaurant-grade deck heater that could warm a handful of guests. But what if it rains or snows? We’re fortunate that our kids will be able to return home for Christmas. But because one will have been on a plane, the other on campus, we will likely stay clear of our extended family in December.

None of this is tragic of course–we are healthy, for now. More intimate versions of yearly traditions are hardly a disaster. The upside: a reasonable size turkey, one less tray of stuffing and more in-depth conversation.

I’ve noticed that my family and friends are careful not to complain too much about their pandemic malaise, acutely aware of the kind of emotional, physical and economic suffering that plagues so much of the country. There is guilt attached to wallowing when others have it worse. But perhaps one holiday gift we can give ourselves and those in our orbit is the freedom to acknowledge how much this has impacted us–changed us–left us without many simple joys, like connecting over a turkey and stuffing, around a tree, or to light candles.

As anyone who has had a birthday in this pandemic season understands, our celebrations this holiday season will be different–or at least they should be. And while they will be stunted, we may find in them something new, and some familiar comfort in their rhythms and joy.

Back to College Reflections ‘The Pause Button’ … and Accepting Change

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Me, just chilling at home, like I’ve been
doing for MONTHS.

Growing up, I was always that kid who called their mom to pick them up from sleepovers. I don’t know if it was because I didn’t like being away from home or because I missed my parents too much. Maybe it was a combination of both.

It’s funny because I was the one who started researching sleepaway camps and eventually found the one that my sister and I went to. I think it’s because I felt like it was something that big kids do. And yet, every phone call would end with me gulping down my tears, every visitor’s day would end with a counselor needing to calm me down and one year, every night I would fall asleep listening to my parent’s wedding song. It’s okay, laugh at me. My parents do.

When it came time for me to go away to college, I was so nervous. Would I be okay on my own? Surprisingly, I was fine! I mean, I ended up transferring but that’s a story for another time.

Like people say when relationships fall through, I’ve come to the realization that it’s not “you,” it’s me. It wasn’t where I was sleeping over or the summer camp I went to. I am just a homebody. I like having my two feet on the ground where I am most comfortable.

So when COVID hit and the world came to a halt and all college students were sent home, I really wasn’t devastated by the move.

I was made for this!

While a lot of my friends cried and were really sad to leave college, I came to terms with it pretty fast. Yes, I was sad that I’d be missing my first spring in Boston. Yes, I was sad because I finally felt like I found my groove in a new city and was finally enjoying college and it was put on pause. But…

I get to hang out with my twin sister, my parents and my dog? Sleep in my own bed? Not have to shower with shower shoes? This was a deal that I could be okay with.

Being someone that loves a routine and hates change, I found a good system at home that I have stuck with since March that consists of exercising daily, making pancakes way too often and putting most of my energy into my blog (shameless plug for operationhappinessblog.com or @operationhappinessblog on Instagram). Oh yeah, I also had online classes I had to squeeze in. But those didn’t cause any stress, just a lot of snack breaks and a severe focusing problem toward the end.

Initially, I would talk with my friends from school 24/7. It was like we never left. But as the months went on, I noticed that every day it would basically be the same: Hey, miss you! What’s new? Nothing? Same.

It became harder to talk to my friends every single day when there was literally nothing else to say. How was texting supposed to be the main form of communication I’d have with them for the next six months? Long distance is hard, especially when both parties are stuck at home doing nothing.

While I cherish my friendships greatly, if you know me, you know how important my family is to me. In high school, there were plenty of Friday nights where I said no to plans with friends because I would rather sit on the couch with my parents, eat candy and watch a movie.

Well, as you can imagine, there’s been plenty of candy eaten and plenty of couch sitting since March as a family. My parents were no longer empty nesters for a span of six months and I suddenly became attached to being home more than ever.

I was content. I couldn’t relate to the feelings of my sister or peers who were saying they just HAD to leave home and go back to school. Of course I want to go back, see my friends, decorate my apartment and eat from my favorite takeout place. I also know that if we were sent home again, I would be totally fine.

I can’t help but worry that leaving for my junior year of college is going to be much harder than leaving for school my freshman year. Things have changed. The world has changed. I’ve changed.

School is inevitably going to be different because of the times we are in. But I have a feeling that my habits will remain the same, now more than ever…me, sitting on my nonexistent couch because my apartment is the size of a toddler’s shoebox, eating candy and watching a movie with my roommates. Sorry Mom and Dad, you’ve been replaced. But I’ll be home soon.

The Corona Chronicles: The Good, The Bad and The Ugly

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Creative pursuits: A lemonade stand with proceeds going to frontline healthcare workers

This past February my neighbor and I drove to the city with our kids to see National Geographic Encounter’s Ocean Odyssey. As we sped down the Saw Mill, she asked me if I’ve been following the news about a new virus called COVID-19 that originated in China and was now raging through Italy. Yes, I had heard murmurings but the illness was somewhere else not on our shores. “Buy toilet paper, Purell and plenty of wine,” she said. Thank goodness for well-informed neighbors.

Now that my kids have completed iLearning, I’ve had the time to reflect on how COVID has impacted our family. Each family has had their own struggles living in the “new normal” and this is a glimpse into ours.

The Good

Let’s start with the good. Life pre-COVID, our life was in the fast lane–running from one activity to the next from after school activities to birthday parties to playdates. COVID put that to an abrupt halt and our lives have slowed down significantly. My mom always admonishes me saying that we run ourselves ragged. “You didn’t have a million after school activities and you turned out ok.” Hmm, maybe she has a point.

Isolation forces your kids to come up with their own entertainment when they weren’t on devices. I’ve enjoyed watching my kid’s creativity blossom from making a lemonade stand to raise money for frontline healthcare workers to devising carnival day in our house, my kids have created fun options that don’t even cost a cent. Having weekends devoid of activities, we’ve had a chance to explore treasures in our backyard with hikes at Ward Pound Ridge and Pruyn Sanctuary.

We’ve had more time together and one of the best things about this has been our ability to have dinner as a family every night. With my husband’s long hours in the office and frequent business trips, we sometimes managed to only have dinner as a family once or twice a week and I’ve always wanted more of them – but be careful what you wish for. I’m up to my eyeballs in dirty dishes with everyone home 24/7.

The Bad

I am not a patient person and some of my most harrowing moments of this pandemic has been iLearning. I realize how fortunate I am – I haven’t lost loved ones or have a job that puts my life at risk during this pandemic but iLearning has tested every fabric of my being. I had to sit down with my first grader for almost every assignment, prod my fourth grader into completing assignments and then harass my sixth grader daily who at first showed the most promise with iLearning but then lost motivation after it extended beyond anyone’s wildest imaginations. The yelling, the crying, the role of being the resident nag–it was all too much. And all this fighting was going on with my husband in his home office trying to be on conference calls. “My clients are wondering why WWIII is going on in the background,” he said so many times I lost count. So I let my kids go back to playing Fortnite as default entertainment.

The lack of planning for a dinner with the grandparents or a trip to a museum in the city has filled me with sadness. It’s this lack of possibilities and planning for the future that I am mourning most during COVID which leads to the ugly section.

The Ugly

The lack of predictably with COVID and who will fall victim to it scares me. Right now with the NY infection rate hovering at 1% as we go to print, I feel like we are in a “sweet spot”. It’s only a matter of time though before it gets worse again according to epidemiologists. And so I wonder should I stock up again on canned beans and Clorox wipes?

Each morning I scan the New York Times headlines. Never before have I felt so hopeless about our future. The politicization of mask wearing, the high infection rates in the Sun Belt, the double-digit unemployment numbers and the racial disparities in how this disease is affecting our nation, it’s too much to absorb. I now shut down after reading for a half hour instead of compulsively reading like I did in the early stages of the pandemic. And each afternoon while I hash out the day’s headlines with my neighbor in my cul-de-sac during a “COVID cocktail hour”, I’m grateful she suggested in February that I stock up on wine.

Local High School and Middle School Students Respond to the Impact of a Pandemic

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On January 20th, the first case of COVID-19, the disease caused by the new strain of coronavirus, was reported in the United States. Ever since then, reports of cases continue to grow exponentially with states all around the country shutting down schools and workplaces.  Hospitals throughout the County in hard hit New York are preparing for an onslaught of cases as virus testing ramps-up and have begun to repurpose their facilities to treat coronavirus patients. On March 18th, President Trump signed the Families First Coronavirus Response Act which expanded access to testing, food and medical aid.

According to the Centers for Disease Control and Prevention, the virus is thought to spread mainly from person-to-person or from contact with contaminated surfaces. Due to this, both secondary schools and higher education institutions all around New York have been shuttered and are being replaced by remote or distance learning. The CDC has also introduced the concept of social distancing and self-quarantine within towns and communities in order to prevent the spread of the disease. At the individual level, this means maintaining a personal distance of six-to-ten feet while in a public space. At the community level, it means banning large gatherings in places of worship, restaurants, sporting events and gyms to mention a few.

Social distancing is widely supported and is quickly becoming the norm in many households. However, many people are experiencing feelings of isolation in their homes.

Caroline Gershman, a junior at Horace Greeley High School is one of them. While being self-quarantined in her house, she realizes that there are restrictions from many of the daily activities she used to partake in.

“Quarantine wasn’t so bad at first because it just felt like a long vacation. Now, I feel a little trapped because I’ve barely seen my friends or done any of the normal activities that I would’ve done to pass the time,” Gershman asserts. “The worst part is probably knowing that this could go on for an undetermined amount of time.”

However some others are not experiencing the feelings of confinement that Gershman is describing as internet use explodes. For that reason alone, Ethan Wecksell, a sixth grader at Bell Middle School, hasn’t felt the effects of self-quarantining. “On the weekdays I use Zoom to talk to my friends and teachers. I don’t feel the need to cope with quarantining yet. Because I’m talking to my friends over Zoom, my life hasn’t really changed.” With the increased amount of time students are spending at home, it is worth questioning whether they are spending more time with family members. “The ratio of time I spend with my family members to time on screens is 7 to 3, but there is also a gray zone where I am on the screens with my family members.”

Regardless of the dramatic changes to their daily lives, people are discovering how their daily routines have changed during this unprecedented period.

Town resident, Cat Wecksell describes how being at home all day made her reflect on how she lived her life.

“Things are less rushed around the house and I do feel like we have had a moment to exhale. Even just reading some of my activity cancellations makes me realize how much I was running around and taking them places, and how hectic that was.” She also describes how being in quarantine at home impacts her familial relationships. “I really try to strike a balance for family time. There are times we all are together, but also time to be apart which I think is very important, especially under these conditions. Also, we are having dinner together every night – actually almost every meal together. Before we would try to have dinner a few times a week together but sometimes people had activities and we had to be divided at dinner time.”

Zain Jafar furthers his passion for golfing during the school shutdown. Photo Credit: Zain Jafar

 

 

 

 

 

 

 

However, both school closures and social distancing are creating feelings of disappointment among high school seniors looking forward to graduation and prom. Zain Jafar, a senior at Horace Greeley, explains how social distancing has impacted him. “I think I speak for any senior currently when I say this entire situation has really brought an abrupt stop to our senior year. For many of us, the next few months were supposed to be a euphoric stream of lasting memories. There was so much to look forward to.” However, he also sees the silver lining: “One advantage of the quarantine is that I’ve been able to be in the company of my family, without the normal distractions. It’s really nostalgic: I feel like a little kid again, happily watching movies and playing board games with my parents and my siblings. Something about that feels right just before I leave for college.”

The COVID-19 virus and its impacts on broad swaths of society is unprecedented in modern times. The responses and actions not only as a local community, but as a nation during this period will allow us to reflect on the lessons that can be learned in order that we can all be better prepared for possible future occurrences.