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Reflections from the Precipice

November 23, 2020 by Inside Press

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.

 

Filed Under: Surviving COVID-19 Tagged With: COVID-19, Covid-related depression, emergency, Emergency Department, Emergency Physician, Family, Future, hospital overcrowding, Mask Wearing, pain, Physical Distancing, precipice, Surviving Covid, vaccine

The Experience of Being a Single Mom and Going it Solo during COVID-19

May 7, 2020 by Inside Press

The following was written on April 13, 2020, as an FYI, and edited here for publishing clarity. Three plus weeks later, the feelings are pretty much status quo, although I’ve settled into more of a routine, which helps. Like many, I imagine I’d be in a state of acute despair without Governor Cuomo’s daily briefings or summaries.

 

 

 

 

 

 

I simply wish to bear witness to my personal experience as a Single American, Empty Nest mom staying home solo and doing my best to follow the new COVID-19 rules. 

My 23-year-old son lived with me for Month 1 of ‘all this.’ Renewed bonds, his humor, mine too, all helped ease the transition to this ‘new way.’  I loved having him here, in fact, after two plus years since starting empty nest in earnest (that is, post his graduation from college when he moved into the city permanently). 

It may appear at first glance that I rescued him bringing him home to the burbs after he developed mild symptoms, got diagnosed as positive with COVID-19, and recovered here, but I know the truth now.

A certain household structure of cooking and meal preparation is comforting and calming. Permission to and the ability to take care of a loved one are absolute gifts, too.

Please never take any of that for granted, ever, not for a minute.

So…

This one is for all the single people living in what boils down to, what is amounting to, a stretch of house arrest.

But ok, without the ankle bracelet.

Yes, social media and FaceTime calls with kids, family and special friends help. It has been especially heartening to keep up with my daughter almost daily as I had been feeling we had grown apart. She has taught herself new skills, and I’m planning on blaring about them soon too, if she’ll let me.

Yes, absolutely, a Zoom meeting or the sometimes seemingly infinite number of fitness or meditation classes and musicians and entertainers and political/educational forums online breaks things up and absolutely does help with motivation or to keep spirits up.

I’d have been lost for a stretch without private stretching/exercise sessions with a therapist from New Castle Physical Therapy for a back-related issue.

Laughter has been key to so many getting through this, so trust me that all the funny online posts in goofy Facebook groups or from all the self styled comedians out there are amazing lifelines for me, too.

I marvel at all the ingenuity and entrepreneurship and ponder the transforming future of where we will all land in the realm of real time versus virtual time. 

Still.. I spend a lot of time online for my work, so I look forward to getting off line… so there’s that. Ultimately, online communication is not like having humans in proximity in your home-whether it’s hearing the sound of a voice or seeing the gleam in someone’s eye. If you are a people person, which I am, by and large, the absence of  ‘actual’ time together is felt deeply.

If you don’t own a pet, which I don’t anymore (a long story for another day, perhaps), yes, it’s far worse than that.

I hear a lot: “I can’t imagine not having my dog through this (or dogs, or cat, or cats).”

Well, imagine it. Many single people do not have pets for a variety of reasons. At this juncture, I don’t have a pet. Not even a fish. And that is that, too. I am not looking for leads on getting a pet, so please, dear reader, do not go there. It actually hurts for you to. I’m fully aware of the options, and let’s just say, it’s complicated.

For me, all I know is that today is Day 10 of alone during COVID-19. For many, it’s well into the 20s, 30s or even 40 plus days. I contemplate the continued impact of long-term isolation. 

Whether it’s your kid’s groan when you tell him to get back to his homework, or your spouse or significant other yelling out, “What’s for dinner?”, please don’t underestimate the value and comfort of a voice that’s in proximity to you. I wonder: Will I settle into isolation? Will it get easier? Harder? Impossible to bear?

I am a person who considers my mental health as intact, stable as she goes. But anxiety is taking hold now, and I’m keeping a variety of toll-free numbers handy. 

The days are much easier than the nights. I am intensely grateful to live where there are many neighbors in proximity, at least. I take my near daily walk for the people and pet visuals, for the dose of Vitamin D, too. The sun sustains me like nothing else. I appreciate even a wave from six feet away at the occasional neighbor, or even someone’s puppy or dog wagging its tail. 

Neighbors’ eyes sparkle and even the wrinkles surrounding them ‘speak’ to me from above the bridge of a nose and circumference of a mask. If they are not wearing masks, I keep my distance, wave anyway, and pray they simply stay safe, too. 

I like getting into my car for the reminder of the old normal as I set about to perform only the most necessary errands. I gratefully take in the ‘hum’ and ‘sounds’ of the market, or at the pharmacy, too. Those fill the soul some, too.

When night falls, a certain fear takes hold, a sense of vulnerability that’s hard to explain. Maybe it’s when all these feelings of aloneness peak. Watching TV, binge watching especially, helps a good deal. I mourn the end of any good series! When I turn the net and TV off, though, it’s me again, and… the pockets of dark space. I’ll slog through some darkness, contemplate the dishes in the sink, but usually choose to leave them for the morning. I try to reduce the night hours by going to sleep as early as possible. Sleep is a bit of a messy affair, too, also the subject of a future post. 

I won’t venture too much here into the lack of touch or intimacy and the total weirdness of virtual dating, or rather, foregoing virtual dating, for the most part.  For reasons also best left to another column, perhaps, I will say I don’t feel this is the time to embark on new romance, either. For personal reasons, I wasn’t necessarily ready for new romance before COVID-19, and I don’t believe that has changed. If anything, those feelings are exacerbated. Still, I’ve always been in the never say never school, too. 

I don’t want pity, but compassion and understanding are great. I don’t need advice or suggestions either. Or maybe I do. I don’t know.

I understand my feelings are unique too, and not universal.  An old friend, similarly alone, is not experiencing it this way at all, and even expressed a comfort level with the isolation, so go figure. She describes herself as perhaps always having been an introvert and that somehow ‘all this’ is suiting her.  I would describe myself as more of an extrovert (although a shy one, too, in a way, as contradictory as that may sound), so perhaps we are hit a bit harder. Then again, I always loved my alone time, too, but by design. And choice. So, again, I don’t know.

I am not writing this to compare pain and painful situations. The tragedy is devastating and on some days, beyond all comprehension. The disease has hit terribly hard taking tens of thousands of lives across the country, hundreds of thousands across the world, and threatening the health of family members, roommates, as it devastates nursing home residences, in particular. Prison populations have also been horribly impacted. And so on.  Solo in my otherwise comfortable suburban pad is certainly also better than any domestically violent situation in any socio-economic circumstance.

And yet, what I want to convey, is that pain is relative, and that the pain here is real for me, too.

Human beings are largely social creatures. Our souls are tested, and I believe shrink in any prolonged isolation. I want to erase the stigma too that anyone weathering this solo is similarly feeling. I know that I’m not alone with these feelings, and that they are widespread.

And yes, yes. I am still counting my blessings to be alive and healthy. I was never going to even share these words as I worry  they may sound somewhat self indulgent or morose. But then again, if a pandemic is not the time to feel those things too, then I don’t know what is. You are welcome to search elsewhere for inspiring and uplifting right now.  I have tried to keep busy sharing all the drama and news I possibly can through this press on a most limited budget. I have plenty of work to do to make sure my 17-year-old business survives COVID-19.  I’ll overshare too that it can feel like wading through molasses. I go through all the steps I’m advised to take as a small business and wait for those to bear fruit.  And wait.  I have rooms and a garage I promised myself I could declutter now, but somehow, paralyzed to, since that feels like the ultimate solo punishment.

I write this simply to self-express (that helps me, so forgive me if my oversharing causes you any discomfort). Finally, I share also to express that I do feel empathy for everyone weathering this storm. My heart goes out to all of you, to those single and to those in semi full or very full houses (maybe we can trade places for a day?) and all your own unique challenges.  And yes, I must believe that we too can get through this, #AloneTogether, and #NewYorkTough. Or when you’re not feeling so tough sometimes, too. 

 

Filed Under: Surviving COVID-19 Tagged With: #AloneTogether, #NewYorkTough, Alone, anxiety, bear witness, Binge watching, Companions, darkness, despair, empty nest, experience, extrovert, Facebook, Governor Cuomo, Household, isolation, Laughter, Mental health, online, pain, people person, pets, Physical Therapy, single, Single Mom, Single People, social, Soul, virtual, Virtual Dating, vulnerability, Zoom

Suffer from Migraines? Patient Advocate Lisa Jacobson & her Site Offer Hope & Resources

April 21, 2018 by Bettina Prober

Lisa Jacobson, Patient Advocate

Chappaqua resident Lisa Jacobson knows migraines. As a chronic sufferer for the past 30 years, she has endured more than 9,000 migraines, tried more than 120 treatments and seen countless doctors. But she is also an entrepreneur who decided years ago that she wanted to use her business skills to help solve a formidable health issue that is often stigmatized.

“I wanted to help people somehow, and I realized the one thing that I was really expert at was migraines,” she said. And so began The Daily Migraine, a website (www.thedailymigraine.com) and community forum dedicated to helping other migraine sufferers. Founded in 2014, The Daily Migraine now has more than half a million followers on its website, Facebook and Instagram pages.

Jacobson was not new to entrepreneurship. In 1983, when she was 24, she founded Inspirica, a test preparation and academic tutoring company that now has more than 100 employees worldwide. She used the skills she honed there to build The Daily Migraine. She now devotes 40 hours a week to researching, creating content and monitoring the site and another 40 hours a week at Inspirica.

Creating Community for Migraineurs

The Daily Migraine is chock-full of information and tools for migraineurs (people who suffer from migraines) to use to help navigate their disease. Visitors to the site can download forms to help track their migraines, speak to their doctors, and write down any treatment ideas they think of. But most importantly, it offers a community that migraine sufferers can connect with.

“People who suffer from migraines don’t feel alone anymore,” she said. “When I first started getting daily migraines after neck surgery, I only found one other person in Chappaqua who also suffered from them.” Since this was before the onset of social media, it was very difficult to find a support system. Now, the website brings migraineurs together from all corners of the world, including Iraq, Nepal and of course the United States. This sense of community is a comfort to many people.”

A Stigmatized Illness

Additionally, there is often a stigma associated with migraines, as many people think that having migraines is just like having a bad headache. But according to Jacobson, migraines are actually one of the most debilitating diseases in the world.

“I’ve heard from a lot of people that their bosses or spouses think they are just shirking their responsibilities when they have migraines,” she said. But migraine sufferers experience much more than head pain. Extreme sensitivity to light and sound, throbbing headaches and nausea are also common symptoms. Others experience stroke-like symptoms and are not able to function for days.

Providing a Patient Perspective

Since founding the site, Jacobson has become the top migraine patient advocate in the world. She has spoken at conferences internationally, including the American Migraine Foundation and the International Headache Symposium, providing doctors with a much-needed patient’s perspective.

“Some of these organizations have been around a long time but never had patients involved before,” she said. “I recognized a need for more information for the migraine community,” which the website provides.

There is no cure for migraines, and figuring out what treatment works best can often take years. Most migraine sufferers try different preventive medicines for three months at a time. But there is not one migraine medication that works for everyone. In fact, according to Jacobson, most medications are ‘borrowed’ from other diseases. For instance, many people found that Botox relieved their migraine symptoms, but Botox was not created for this specific use. It is also an undertreated illness; there is only one accredited migraine specialist for every 40,000 migraine sufferers.

Raising Funds for Migraine Research

Jacobson’s goal now is to raise money and awareness for migraine research. She has partnered with Chappaqua resident Scott Boilen, President of Allstar Products Group, to create the Migraine Hat. The hat, which costs $29 and can be ordered directly from the site, contains an ice pack to help soothe the pain. All of Jacobson’s profits from the hat will fund migraine research.

“People have said that the Migraine Hat is revolutionary,” said Jacobson. Since cold soothes the pain, “if you have the hat on, you can function. It takes a migraine that has a pain scale of 8 down to a 6, which can be the difference between lying in bed all day or putting your kids on the bus.”

Luckily for Jacobson, she has finally found a treatment plan that works for her. “I started The Daily Migraine when my migraines were at their worst,” she said. But after trying many different combinations of traditional medicine, stress-release tactics, and lifestyle changes, her migraines started to dissipate. Being pain-free has enabled her to focus on the site and help others.

“It’s like I have my life back again,” she said. Her success with alleviating migraine symptoms after so many years is also inspiring to The Daily Migraine’s many followers. As she said, “Now, I can also offer hope.”

Filed Under: Armonk Cover Stories Tagged With: headaches, Lisa Jacobson, migraine relief, migraines, pain, Patient Advocate, The Daily Migraine

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