I’m Tired

I don’t have a blog post prepared so I am winging it. The past week was a tiring one. It started off with a dental appointment to put a crown on a tooth that had previously had root canal. The process of preparing the crown left my mouth sore. I don’t know about you, but I don’t enjoy when they insert the tray with the gooey stuff in my mouth to make an impression of my teeth. I remind myself to breathe so I don’t gag. I prefer not to have someone putting their hands in there to drill either- the vibrations cause my ears and sinuses to ache. Invariably my jaw is sore afterwards. It took a couple of days for that to settle down. Great start to the week.

Then I went down to New Jersey to accompany my mom to her pulmonologist appointment. I wanted to go (Mom, don’t feel guilty!!). I don’t mind a road trip. I listen to podcasts, NPR and music. As long as traffic isn’t bad, I’m good. I wanted to be there to hear directly what the doctor said, to support Mom and to spend some time with her. The issue is that the visit to the doctor was not great. I’m not going to go into details, but we left with more questions that we arrived with. Mom is doing okay, but not as good as we would like and frankly, I worry about her. (Mom, don’t feel guilty!!) It is hard being 3.5 hours away.

That night, after the unsettling appointment, I had a zoom bookclub. I signed up for an offering from my local library – the club meets virtually to discuss 7 Pulitzer Prize winning novels that explore the American experience. The assignment for this meeting was Humboldt’s Gift by Saul Bellow. I’m not going to digress too far on this, it could merit its own blog post, but I would describe the read as a slog. Reading a book should not be a slog. I fought through it, at least in part out of respect for my fellow bookclubbers. The facilitator of the session, who I like very much, opened the meeting by confessing that he couldn’t get through it! Part of me regretted that I had put in the effort, but, in fact, I’m glad I did. It wasn’t great timing in that I had other things to do, but I did get something out of the experience. One thing I learned: I will not read another Saul Bellow novel. I read one in college, Herzog, which I also remember as a painful experience. I think two is quite sufficient for my lifetime. I may write more about Mr. Bellow’s novel another time. I enjoyed our discussion which centered on whether we feel an obligation to finish a book we have started. What do you think?

The week proceeded with preparations for Passover. Last year we did a virtual seder which worked out pretty well, all things considered, but certainly isn’t what we prefer. This year, since Gary and I are fully vaccinated, our children came and we zoomed with my husband’s sisters. I love having a full house. I loved having Leah, Ben, Dan, Beth and our granddaughter here.

Our granddaughter woke up at 4:15 a.m. Saturday morning. I didn’t want her to wake her parents – she was starting to cry and we had the monitor in our bedroom – so I went in to her. She settled quickly. I didn’t. I got back into bed and thought about everything I needed to do. About 6:00 a.m. I fell back to sleep. Our granddaughter woke up at 6:15 a.m. Fortunately, Gary was happy to get her and I fell back to sleep for another hour and a half. Despite that I got up not feeling particularly well rested. A small price to pay, but as I get older it gets harder to rebound. I thought to myself, “I don’t want to be 61!” as I brushed my teeth. Of course it is better than the alternative.

During the weekend we laughed, we chatted, we prepared the seder meal (three of us combined efforts to make the turkey and it paid off), we ate multiple meals actually. We played Trivial Pursuit. My granddaughter not only chose me to put her to bed both nights, but said, “Nana, I love you.” Nothing is better than that. I will treasure the memories and look forward to the next time we get to be together.

Now it is Monday morning. I don’t have a blog post prepared. But that’s okay.

Passover bouquet on my dining room table

Crime or Misdemeanor

Photo from Chad McMillan

‘Crimes or misdemeanors.’ My husband uses that phrase when we talk about making judgments about people’s behavior. We are walking in our neighborhood and I am telling him about my distress because someone disappointed me. After listening to me vent for a bit, he will ask, “Crime or misdemeanor?” a reminder to put things in perspective. Do I want to hold a grudge? Do I want or need to discuss it with the person? Gary isn’t saying it to minimize my emotional response to the incident, but to ask me to step back and look at it afresh.

Some transgressions are minor, others far more significant and it is useful to make that distinction. It is relevant in terms of how we evaluate the person’s character and assess the consequence. Lately, particularly in the context of the #MeToo movement and accusations of racism, it feels to me that we are losing the capacity to be discerning, especially about the punishment. I think there is something to the argument that ‘cancel culture’ has gone too far, even if the phrase is a Fox News favorite.

I believe Harvey Weinstein got what he deserved. Even if one wanted to say he was canceled, he should have been. In my saying that the pendulum may have swung too far in canceling people, I am not offering a defense of indefensible behavior. Rape, assault, stalking, unwanted touching, ogling, unwelcome flirting are all unacceptable, but they represent a range of wrongs. I think we need to ask what the appropriate punishment is depending on the offense. In the context of sexual harassment at work, options could range from criminal charges to a warning. Potential responses include referral to the police, an internal investigation, bringing in an outside consultant, a counseling memo in their personnel file, firing, required training, reassignment or some combination of these. Perceptions will vary about the appropriate response. The problem we are up against is that for years and years and years, nothing was done. Women weren’t believed or the problems were swept under the rug. Perhaps in reaction to that, we are overcompensating now.

When the New York Times reported that Peter Martins, the director of the New York City Ballet (NYCB), retired because he was being investigated for creating a hostile environment, which included sexual harassment, my mother was outraged. It wasn’t clear whether the investigation had been completed when his decision was made (it seemed he was forced to retire). Mom was a huge fan of his dancing – we both were, we followed his career and enjoyed his performances over the years. She thought he was being treated unfairly. I argued that the organization likely had a lot more information than what was in the paper. I reminded her of some incidents that had been reported about him in the past. I also made the point that NYCB likely didn’t undertake a major investigation and accept his retirement without good cause. I asked her “Why would you assume that the charges are all lies?” She still thinks he was done wrong. While I don’t know the details, I don’t believe he was ‘canceled.’

In part the difference between my mother’s and my response is generational. Some behaviors that today we recognize as inappropriate were acceptable or expected to a woman of Mom’s age. Some of the #MeToo reporting didn’t sound so bad to her. (Let me be clear, she does not think sexual harassment is okay.) A coach was allowed to be verbally abusive. Sexual innuendo was part of office banter – at least in some places. A man giving a woman a compliment on her appearance may have been appreciated – it may still be.

There are intangible things at play – whether it was 50 years ago or today. Two men saying the same thing can be received very differently – tone of voice, body language, previous interactions, the look in their eye all inform the meaning of the words. “Pretty dress,” can sound innocent or lascivious. Two women hearing the same comment may respond differently – one may be flattered, another may be uncomfortable. One person may be motivated by a coach yelling, another may shut down. We can acknowledge that this can be fraught without giving up making judgments. We also can’t sustain knee-jerk reactions to every accusation. We need to make the effort to navigate this messy, confusing and difficult terrain.

We also can’t know a person’s intention. The law makes distinctions based intentionality – harming someone purposefully is different than accidentally. It can be hard for prosecutors to establish intent; harder yet in a harassment claim. Did they mean to make someone uncomfortable? Are they on a power trip? Are they racist or ignorant? Does intention matter? Yes and no. Sometimes the action speaks for itself. The guy in Atlanta may deny racist intent after he murdered six Asian-American women, but what he did belies his words.

Ignorance is an inadequate defense, too. If you make no effort to educate yourself, then you bear responsibility for not knowing the meaning of words or symbols. Is it believable that a person doesn’t understand what a swastika represents?

 Another question is: Can we give the harasser an opportunity to redeem themselves? I am troubled by the idea that people are written off or deprived of their career without slowing down to investigate and then give due consideration to the punishment.

What guidelines can we use? I think it can be helpful to ask what if the behavior/action happened to our child, spouse, friend or relative? Imagine yourself as the victim. See if that empathy changes your perspective.

By the same token, ask yourself if the person who is accused was your spouse, child, friend or relative, what would you think is fair? Does that change how you would like them treated?

We also need to be cautious in reacting to what we see in the media. Sensational headlines get attention. Sometimes the full story gets lost. Let’s all take a breath.

Accusations should be investigated, fairly and thoroughly. Once facts and perceptions are understood, we need to find a just response; one that is not inflamed by political extremism, righteous anger or a rush to judgment. In the long run, we all benefit from a thoughtful, fair process. We don’t want the pendulum to swing too far back in the other direction, silencing voices that have only begun to be heard.

Cuomo esta?

Governor Cuomo is in trouble. I have mixed feelings about that. He is a complicated public figure. I can’t claim to have first-hand knowledge of how he operates but having worked with his administration on education issues and knowing folks who have attended meetings with him and living in the Albany area for the last thirty years, I have certainly formed opinions about him. Before the pandemic, my impression was largely negative, even though most of his policies aligned with my own views. I did not like the way he did business.

Recent reports that Governor Cuomo or his aides threatened to ruin the careers of adversaries are very believable. I think that has been Cuomo’s modus operandi for most of his career. The evidence suggests that he is a bully. Maybe our culture is changing such that his behavior has become unacceptable and that would be a good thing. I think, to varying degrees, bullying in the workplace has been acceptable in the past. I have worked with men who got away with a version of that – yelling and intimidating people to get their way, driving employees to tears. Maybe they didn’t go so far as to threaten to ruin careers, but scaring underlings was a tool they used. Perhaps they had anger management issues, but nobody called them on it. From what I have observed, some men benefitted from the behavior. Cuomo may be caught in a changing tide. What was once okay (or at least overlooked) is now not. One question this raises is: what is the penalty for that? I’m not sure that the punishment (forced to resign or impeached) meets that crime. Is it enough for him to acknowledge it and pledge to behave better? (If he was willing to do that.) Should he be forced to step down?  It would be a simpler calculus if that was all he was accused of.

The allegations of sexual harassment are another matter. I have to admit that these charges came as a surprise to me. It was not something I heard whispers about before, though that doesn’t prove anything. At first, I wondered if the allegations were actually more about how his bullying behavior manifested with women. The first reported complaint that I read about, back in December, sounded like that. Creating a toxic work environment was consistent with what I understood about him. Unwanted touching, though, is a whole other thing. The incident at the wedding where he cupped the young woman’s face (she wasn’t an employee of his) and asked if he could kiss her sounds like he was being a creep (perhaps drunk?) and doesn’t reflect well on him but does not seem to be harassment. Now there have been other allegations that involve more aggressive unwanted touching of employees. The question this raises is:  should he resign based on the allegations? I think the investigation should play out first. I know that in the heat of the stories emerging, it is tempting to leap to conclusions, but a rush to judgment isn’t fair. I think there has been too much of that.

Then there is the nursing home situation that is also being investigated. The issues here fall into a couple of different categories. The coverage I have read has focused on the wrong things. The number of deaths reported in which categories is less important than the facts of the deaths. We need to understand what happened and what can we learn from it.

Throughout the pandemic, at all of those press conferences which I watched, the person I was least impressed with was the Health Commissioner, Howard Zucker. He did not inspire confidence, unlike the Governor. I know he, and the whole administration, was faced with an unprecedented crisis. And, to add to the challenge, they didn’t get guidance or support from the federal government. Even cutting Zucker some slack for that, I don’t think he performed well. His role in managing the nursing home situation needs to be understood. While the buck stops with Cuomo, I have to assume that decisions about protocols were largely informed by medical advisors. What guidance did Zucker offer?

The first question with the nursing homes is: what guidance did the state give regarding Covid patients? Were nursing homes given support, in terms of PPE, respirators, or treatment suggestions? Was the state made aware of what was happening on the ground? How timely and adequately was support given? What instructions were the hospitals given about releasing Covid patients back into nursing facilities? If the Attorney General’s investigation answered these questions, I didn’t see much coverage of it. These are far more important questions than whether nursing home deaths were erroneously counted as hospital deaths. No one has said that the total number of deaths was undercounted.

I can imagine, in the midst of the crisis, that it was all a giant clusterfuck. Some of it can be forgiven because no one knew what to do, but if decisions were made that led to more deaths, we need to understand that. Not for the purposes of punishing someone necessarily, though if it involved negligence or willful disregard for human life then we would need to assign consequences, but rather so that we learn and do better. There will likely be another pandemic.

Then there is the allegation that the Cuomo administration lied on federal forms in reporting nursing home deaths. I am not suggesting that Cuomo gets a pass on the handling of the nursing home debacle. If he directed people to lie on federal forms, there needs to be a consequence. Given the posture of the Trump administration, their incompetence and politicizing of everything, it is easy to imagine the Cuomo obfuscating, if not outright lying. Truthfully when the allegations that they lied on federal forms came out, especially when it didn’t mean that he lied to the us (New Yorkers) about the number of deaths, I didn’t give a shit. I could be missing something, but in the midst of all that was and is going on, with the virus still raging and so many suffering, I thought there have to be more important things to be focused on.

We need to concentrate on the right questions. Unfortunately for Cuomo, he has made a lot of enemies, probably deservedly, and they want to capitalize on whatever they can get on him, regardless of whether it rises to the level of an impeachable offense. Add to that the usual partisan power politics, Republicans would love to take advantage of Cuomo’s weakness, and we have a situation ripe for a rush to judgment.

I took comfort from Cuomo’s guidance during those daily press conferences. He provided leadership that we needed. He deserves credit for that. In the midst of calamity, he made many decisions that saved lives and stepped into a role that should have been filled by the President but wasn’t. How does that fit into the analysis of how he gets treated now?

On the one hand, I like the fact that Democrats demand a standard of behavior for elected officials. I would like some standard to have been applied to Trump. On the other hand, we can’t have knee jerk responses to allegations. Lots of prominent Democrats have come out saying that Cuomo should resign. They say he has lost the confidence of the people of New York. Has he? One thing I haven’t seen reported is what do New Yorkers think? What do the polls show? We are bombarded by polling most of the time. While I don’t like the idea of making decisions based on poll results, it seems relevant in this case since Cuomo is in office by virtue of the most important poll, the one in the voting booth.

I think the investigation(s) should play out. When we understand what Cuomo has done, then we can make an informed judgment about his future.

Note: I wrote and posted this before seeing that Quinnipiac has a poll out showing 55% of New Yorkers approve of Governor Cuomo. I think that supports my point.

A View from the Vaccine Front Lines

Note: The following essay was written by my husband, Gary Bakst, a physician in New York’s Capital Region. Thank you, Gary, for sharing your experience and insight.

It has been a miserable year for all of us dealing with COVID-19.  The virus has killed over 500,000 Americans and infected about 30 million of us.  Some are still dealing with “long haul” symptoms, ongoing effects of the virus.  Sadly, many have lost loved ones to this scourge.  By now, very few of us do not know someone who has had it. 

Beyond the illness itself, the precautions being taken to prevent infection have entirely changed the way most of us live.  We are mostly staying home, working remotely, and avoiding gatherings.  There are no concerts, no theater, no ballgames.  Many of us are not willing to go to restaurants, bars, health clubs or yoga studios. 

For those of us still working in person, teachers, grocery workers, and health care workers, etc., there is the real risk of infection.  And in our office, that concern has similarly been significant.  There are about 90 employees in our office.  We represent substantial diversity in all kinds of ways:  race, age, religion, rural vs. urban, health status, educational and economic status. 

And we have about 300 people who come into our office on a daily basis for doctor’s appointments, to see physician assistants, nurse practitioners, diabetes educators, podiatrists or our surgeon.  They come in for labs and ultrasounds and bone density measurements.  It is a lot of people and a lot of appointments.  Altogether, since the beginning of the pandemic, it represents about 80,000 visits. 

Given the prevalence that COVID has had in our community, it was inevitable that, at some point, people who work in our office would test positive for the virus.  Yet, through the end of November, we had not had one employee test positive.  Our precautions were working. After the Thanksgiving vacation, that started to change. We had first one and then several and then a substantial number of employees test positive.  By and large, it did not feel like transmission was happening within our office although there was quite a bit of worry over that possibility.  Mostly, it was people who presumably became infected outside of work, possibly via contact with asymptomatic people who did not know that they were carrying the virus.

We had at least one example of a physician acquiring infection from contact with a patient who did not know they had the virus.  Personally, I had two consecutive Fridays in which a patient called (or a family member of that patient) that they had tested positive the day after their visit.  Sometimes people just don’t really think they have COVID – maybe they had minor symptoms and got tested but they answered our prescreening questions indicating no such issues. Getting those Friday calls led me to quarantine apart from Linda and certainly raised my anxiety level. Fortunately, I didn’t get the virus and neither did Linda.

Unfortunately, some of my patients have been very seriously ill with COVID-19 and several have died from it.  Many of them were lovely, sweet people with wonderful families.

Most of the employees who tested positive had minor symptoms or were asymptomatic.  Several were more significantly ill.  Several had to miss work for weeks or even months.  Those who were sicker longer have had some issues in terms not feeling entirely themselves even after returning to work. One of the many frustrating things about this pandemic is the unpredictability of the disease.

By early January, I had reached the point where I was seriously thinking that we needed to shut down the office for 10 days.  Then, the vaccine took effect.  I got my first dose on December 28th. It was 2 weeks after we received the first dose that all of this stopped.  Not all of our employees chose to get vaccinated, but the overwhelming majority did. 

Up until that point, the tension, the fear, in the office was palpable among many of our staff. Everyone handled it in their own way.  Some were clearly less concerned, and a few had to be repeatedly reminded to keep their masks on. 

Albany Medical Center saw up to 38 employees test positive on a single day in that period.  After vaccination – just over 90% of their employees chose to receive the vaccine – that number fell to either zero or one positive test per day.  Most of the employees who tested positive were those who chose not to get vaccinated. 

In terms of side effects, many of our staff did have some side effects.  Half of us received the Pfizer vaccine and half Moderna.  I did not notice any difference between those two vaccines in terms of side effects.  I personally only experienced mild arm pain with both doses (of Moderna).  But many in the office had more side effects with the second dose.  Some had fever and chills, some were achy, some had nausea, some were exhausted.  These effects generally lasted typically 12 to 36 hours.  I do not know of anyone in the office who had anything worse or anything that lasted longer.

There have been several concerns that people have raised regarding getting vaccinated.  I want to briefly comment about them:

  1. “They were developed too quickly – something must not be up to standards.”  Actually, they were subjected to exactly as much testing as all of the other vaccines that are produced, it was just that certain steps were done in parallel rather than sequentially.  While all kinds of factors allowed it to be brought to the public more quickly including the promise that our government would pay for many doses, no vaccine went to market until all of the usual safety and efficacy studies involving tens of thousands of people were completed. All three vaccines have been authorized by the FDA.
  2. “Since political pressure was brought to the process it must be tainted.”  While there has been all too much politics involved in so many aspects of our response to the pandemic, those in charge of the vaccine process, thankfully, resisted pressures to short cut the steps we take to ensure that these vaccines work and that they are safe.
  3. “The new technique of using RNA to make a vaccine means that my DNA will be altered or somehow there will be long term effects of the vaccine”.  The messenger RNA does not get into the cell nucleus and does not ever do anything to our DNA.  It is degraded fairly quickly and does not persist in our bodies.  mRNA vaccines have been used before and have been safe and effective.  However, never before has an RNA vaccine been used on this scale so it is absolutely reasonable to continue to monitor for potential adverse effects. 

We are now many months since the first volunteers received the vaccines and their safety record has been very impressive.  Their efficacy has similarly been very impressive as seen in our office.  And the disease that we are combating is dangerous.  We will not overcome it without vaccine.  More than 500,000 Americans have died from it.  With over 50 million Americans vaccinated, not one person has died from vaccine.  The risk of vaccine is so clearly low and the risk of being unvaccinated so very clearly intolerable, even tragic. 

Personally, I am so very grateful to be vaccinated.  I feel less vulnerable and less likely to infect other people.  Being vaccinated has not yet had much effect on the things I choose to do or not to do.  I am still quite careful at work and reluctant to go to places where people gather.  But I am hopeful that much of this will change as more of the people I know receive vaccines and I am encouraged that the availability of those lifesaving shots is increasing week by week.  I hope you are able to access a vaccine soon or have already had one and that it makes your life better and safer. 

Light at the End of the Tunnel?

I want to see light at the end of the tunnel and I probably should be able to, but it has been such a long year. The news has been so painful – so many deaths, certainly many that could have been avoided had action been taken sooner. A year ago, who would have believed that over half a million Americans would die of the coronavirus? The number is unfathomable.

The pandemic has introduced so many wrenches in our plans: from a canceled vacation to national parks last May, to planning a Covid-safe bridal shower and wedding for our daughter instead of the celebrations we were hoping to have, to Zoom meetings of my writing groups instead of getting together in person, and a funeral and shiva for my father-in-law with limited attendance. So many accommodations were made, so many disappointments were absorbed. And we were among the lucky ones. No one in our immediate family got sick, though there were scares and there were quarantines, no one died in our immediate family, and no one is suffering long-term symptoms.

We tried to make the best of it. We still had celebrations. We used FaceTime to visit. Gary went to work, as usual, coming home with indentations on his face from where his mask and goggles pressed against his skin. His hands are rougher than sandpaper from relentless washing and sanitizing. The payoff for his efforts was that, despite some exposures, he has remained healthy and so have I. We took hikes with family and friends, weather-permitting, finding lovely spots nearby to explore. We used our swimming pool more than we had in years. The summer and fall were made bearable by those activities. We used our fire pit more than we ever had even in the winter.

Temperatures reached the mid-40s on Sunday and the rain held off so Gary made a fire.

The winter has dragged on, though. Mostly one day feels like the next. I keep having to remind myself what day it is. Now it is March again.

There are signs of light. My husband is fully vaccinated. I got my first shot just over a week ago, so in another month I should be fully immunized. Getting the appointment was a travail, but the process of getting the shot was well organized and efficient. I was impressed with the whole operation at the Javits Center.

I do wonder if the speed of vaccinations can outpace the speed of variants of the virus emerging. If it doesn’t then we will be dealing with the limitations longer than anyone wants. But production has ramped up and more vaccination sites have opened, so maybe we will get ahead of the curve.

Spring is only three weeks away now; the days are getting longer and that usually makes me feel more energetic. Somehow, I still feel discouraged. Maybe it is the persistent grayness. The temperature has moderated but it still looks so gloomy. The sky is leaden, and the trees are bare.

Some of the persistent disappointment may be that I expected, with a new administration in Washington, there would be more hopefulness. I have no complaints with the steps Biden has taken – things are accelerating, but Trump’s influence is still so strong. I was hoping the fever would break, that the Republican party would be released from the ‘big lie’ of a stolen election and would be free to either return to its more reasonable conservative roots or to adopt a new constructive path. Sadly, this does not appear to be happening. I’ve said it a million times, and I will again: I accept that people have different political philosophies, that some view the role of government more narrowly, that some prioritize individual rights more than the communal good and that this leads to different policy choices. I cannot accept white supremacy or violence. I cannot accept ‘alternative facts.’ How will we move on from this moment?

I know I need to be patient. That is not one of my strengths. I have no choice but to put one foot in front of the other, keep doing what needs to be done, take opportunities to enjoy family and friends, notice the beauty of the full moon emerging from behind clouds against a violet sky… and breathe. Believe in the light even when I can’t feel it.