As a child growing up in New Jersey in the 1950’s and 60’s, one of my favorite things to do when school let out for the year was to get up, ride my bike to the candy store, meet up with friends, pick up a newspaper and check out the baseball box scores from the previous night’s games.
I liked reading about my favorite players. I’d check their batting averages, earned run averages, runs batted in, stolen bases and home runs.
I cannot fully imagine what it is like to be a kid today, at a time when school let out for the first time I can ever recall for reasons other than the school year coming to its natural ending. Rather, it came to an abrupt end for reasons of health, safety, life and death.
That’s a lot for a kid to handle.
The end of school was always bittersweet for me. I was happy and relieved to get a break from the daily routine, and sad to say goodbye until September. It was a ritual that was a normal part of growing up. It was also a far cry from leaving with no decent goodbye and no baseball or box scores to look forward to—only an inescapable sense of incomprehensible dread.
Riding one’s bike to a store of any kind today requires, in addition to a helmet, wearing a mask and gloves and staying six feet apart from everybody else, including your best pals.
As for box scores, the only one you can find in print or on social media these days is a list of states, cities, towns and villages and the corresponding number infected and dead.
Our children left school unceremoniously amid a global pandemic. Whether they say it in so many words or express it through their behavior, don’t lose sight of the fact they are experiencing loss and are grieving all that has been taken from them.
Our kids fear for the future. And you don’t have to say a word for them to see how this is affecting you and how you are managing your own stress and uncertainty.
Although keeping routines at home can help, to whatever extent our kids experienced a sense of normalcy in their lives, their lives are no longer the same. If there was tension in your home before the shutdown, it has likely intensified. Where there were little or no fears about mortality, they may now be pervasive. Loss is a key theme; the loss of normalcy, a sense of safety and hope.
What to do? Try your best to be attuned to and manage your own anxiety. Remain calm. Don’t force, but encourage your children to express their feelings. How? By striving to be a good listener. Do your best to provide them with honest and accurate feedback and information. Be reassuring and hopeful. Limit media exposure (box scores included). And, finally, don’t hesitate to seek outside professional help, which is now available by phone and video conferencing through North Shore Child & Family Guidance Center.
If there is an opportunity, model and encourage kindness wherever and whenever the opportunity presents itself. To paraphrase Mother Teresa, acts of kindness may seem simple, but their echoes are endless and hopeful.
Andrew Malekoff is the executive director of North Shore Child & Family Guidance Center, the leading children’s mental health agency on Long Island. The Guidance Center is seeing new and existing clients via telephone and video during the COVID-19 crisis. To make an appointment, call (516) 626-1971 or email info@northshorechildguidance.org. Visit www.northshorechildguidance.org for more information.
In my February column, I wrote about the fact that I had a stem cell transplant in early December 2019, about a month before I heard for the first time about the coronavirus.
The transplant entailed getting an unrelated donor’s stem cells to replace mine; then, if all went according to plan, these cells would grow into a new immune system to seek and destroy my cancer cells.
As a result of the transplant, all of my childhood vaccinations became ineffective. I was instructed to stay in isolation for at least four months in order to avoid infectious and possibly deadly diseases like influenza. Consequently, I have been quarantined since December.
Just a day before writing this, a friend told me that I’m a “trendsetter.”
I knew very little about viruses before the coronavirus came along—only that they were microscopic infectious organisms that invade living cells and then reproduce. In an effort to review what I had been (mostly unconsciously) protected from before transplant, I Googled the Centers for Disease Control and Prevention (CDC) and found a piece entitled, “Vaccines for children: Diseases you almost forgot about.”
I was reminded that most of us had vaccines as children for some of the nastiest viruses, including polio, which invades the brain and spinal cord and leads to paralysis; tetanus, a potentially fatal disease that causes lockjaw; whooping cough, which can lead to violent coughing that makes it difficult to breathe; and many more.
Most older adults are familiar with chicken pox, mumps and measles. I had two of them as a young teenager. One that I forgot about is diphtheria, which affects breathing or swallowing and can lead to heart failure, paralysis and death. There are several more.
I imagined the panic that parents must have felt and the pain that young children must have experienced before vaccines were discovered to prevent these horrible infectious diseases.
For the time being, I cannot replace my old vaccines. I must wait for at least one year while my new immune system gets stronger.
The idea of being in isolation and maintaining a safe social distance for a few months post-transplant made sense to me. I was well prepared by doctors and nurses and I knew my wife would be a great caregiver, so I thought I could do the time.
And then, the coronavirus came along.
For me, being quarantined was an old hat by the time a national emergency was declared and everything started to shut down. I learned that this new virus’ main target was the lungs and people older than 60 years with underlying health conditions were its primary targets.
I fit the bill and knew that I’d have to do more time: at least another three months, my transplant doctor told me. The only difference is that this time, hundreds of millions of people would be joining me.
I was well-prepared before and after my transplant. I knew why I had to self-isolate and for how long. No one, including me, was prepared for COVID-19 and the mass quarantine that it now requires—not only to protect oneself and one’s family, but also to protect strangers. Mostly older strangers like me.
Scientists and other health professionals were the heroes of viral epidemics gone by. I do believe we will get through this, with people like immunologist Dr. Anthony Fauci leading the way.
Still, the unknown is what is most frightening. We all want answers, yet some remain illusive at the moment. This is an opportunity for all of us to strengthen our tolerance for ambiguity.
When will this end? No clue. Will it come back? No idea.
Although my new immune system needs more time to protect me, I just found out after a PET scan that I’m in complete remission from my cancer.
Will it come back? No idea.
We are all in the same boat, living in uncertainty, whether young or old, healthy or unwell. As Plato said, “Be kind, for everyone you meet is fighting a harder battle.”
Andrew Malekoff is the executive director of North Shore Child and Family Guidance Center. To find out more, call 516-626-1971 or visit www.northshorechildguidance.org.
In my August 2019 column titled “Thank You,” I expressed my gratitude for the cancer researchers and practitioners who have been instrumental in getting me through the last 10 years of my life. As I explained, my cancer was responsive to treatment, but it was persistent and kept reemerging.
Since that piece was published, it was determined by my “team” that I was eligible for an allogeneic stem cell transplant, which meant getting someone else’s stem cells to help rebuild my immune system. Although this is a risky treatment, it does offer the possibility of a cure, which routine chemotherapy and immunotherapy do not, at least not for my type of blood cancer.
The team thought that given my age and overall good health and fitness, this was the best window within which to proceed. After considering all of the information with my family, I agreed.
The transplant was scheduled for December and required that the hospital find a non-related donor. I was fortunate enough that a stranger was discovered through the donor registry.
I spent three mostly difficult weeks in the hospital. The first phase was “conditioning,” in which I received high doses of chemotherapy and total body irradiation. Next came the transplant. The final and longest phase, which I am in now, is recovery. There is the risk of “graft versus host disease”– the possibility of the new cells not only attacking the cancer, but other organs in my body—which is part of what recovery aims to prevent.
Currently, I am vulnerable to many ailments and illnesses as I have the immune system of a newborn baby. It will become stronger over time, and eventually I will receive all of the childhood immunizations, which are now rendered useless.
This is all background that leads to what I really want to talk to you about: my experience with the personnel involved in the transplant.
The three nurses depicted in the photo, along with an attending physician (not pictured), presided over my stem cell transplant on Dec. 12, 2019, at Memorial Sloan Kettering Cancer Center in New York City. Some consider transplant day to be a new birthday. So now, I have two. I don’t know the identity of my donor, although there is a process in which I can communicate with that person to thank him or her directly if I so choose, in due time.
Obviously, as the photo reveals, the nurses are a diverse group. At the time of transplant, I asked them a little about themselves. Among the three nurses are a Muslim, Christian and Buddhist. The attending physician is Hindu. I am Jewish. There are racial and ethnic differences as well.
I teared when I said, “With all that is happening in the world, all of the hate, you represent the truth about the value of diversity.”
With their permission, I snapped this photo with my cell phone from my hospital bed. Amid the rampant and unrelenting stories of hate, this is a graphic reminder that diversity is our strength.
We cannot afford to squander it.
Andrew Malekoff is the executive director of North Shore Child and Family Guidance Center, which provides comprehensive mental health services for children from birth through 24 and their families. To find out more, visit www.northshorechildguidance.org.
Please click the photo to watch the WABC interview and video.
LONG ISLAND (WABC) — Kids aren’t out on the playgrounds, and they aren’t inside their schools as a result of COVID-19.
Several weeks into this pandemic, some families may be settling into this new norm — but others are reaching a crisis point.
“We’re getting a lot of referrals from urgent care, where they are trying not to hospitalize the kids, and they’re sending them to us,” Regina Barros Rivera said.
“They’re beginning to isolate, they’re not sleeping, they’re having passive thoughts of suicide or self harming,” Barros Rivera said.
But she says there’s help virtually. In fact, many therapists are fully up and running now and are even doing intake for new, young patients.
For the Stensland family in Huntington, it was a matter of continuing a group friend session for their 12-year-old son Jimmy.
“I should be interacting a lot more with my friends via text, email, phone calling,” Jimmy said.
Jimmy’s mother Gina Stensland said she thinks sometimes kids need to be reminded.
“It’s so easy to be so lazy once your school work is done,” she said.
Jimmy’s virtual help comes from a group called Kidz Helping Kidz in Melville. That’s where Sarah Wagenberg and her family turn, as well.
“I think as a mom, it’s been hard just trying to keep everyone occupied, get a sense of routine,” Sarah’s mother Marissa Wagenberg said.
The issues range from frustrations due to online schoolwork to more serious health issues that are plaguing families everywhere.
“I have some kids who actually have parents that have the coronavirus, so they talk about that,” Kidz Helping Kidz mental health expert Dana Kane-Glickman said. “They’re very concerned, will we ever go back to school? Will life ever be normal again?”
The pleasant surprise is that they say virtual support is much more helpful than they thought.
Therapists are also getting a glimpse of family dynamics at home in a way they’ve never seen before.
As the Coronavirus pandemic has come to dominate a good deal of our daily lives, are we, as Dr. Suzan Song suggests in U.S. News and World Report, “on the brink of a mental health pandemic that our current system is not equipped to handle?”
Recent polling by the Kaiser Family Foundation found that almost half of U.S. adults said the pandemic has affected their mental health, while more than half believed that they would be exposed to COVID-19 because they could not afford to stay at home financially.
At North Shore Child & Family Guidance Center, where we work with children, teens and their families, we’ve made the transition from face-to-face office, home and school-based visits to remote video conferencing sessions. Although we didn’t formally poll the families we work with, judging by feedback from our therapists, the mental health impacts of COVID-19 are pervasive.
Most of the children we see haven’t come to us because of COVID-19 fears, although we are starting to get referrals specifically related to the pandemic. Nevertheless, everyone we see is impacted by it. The problems that they came to us for in the first place—most often depression and anxiety—are exacerbated by the fear and uncertainty that the Coronavirus brings.
Many of our recent referrals come to us from urgent care or as the result of hospital discharges. Along with depression and anxiety, some are also experiencing panic attacks, crying spells, passive suicidal thoughts and urges to self-harm.
As one of our therapists reported: “Using Zoom video conferencing sessions to navigate family therapy has given me the opportunity to remain connected with the family while working with them virtually to discuss ways they can practice and implement better communication skills. Zoom sessions have also allowed me to work with my client individually to review and practice coping skills she can utilize when experiencing low moods.”
The challenges brought on by the pandemic are significant. Kids don’t know when they will return to school and, for many, when their moms and dads will return to work. Being in close quarters with their family 24/7 can feel like a pressure cooker, particularly when the stress of isolation from friends, economic worries at home and terror about the possibility of a loved one becoming ill and dying are constantly at play.
It’s fairly common knowledge that as many as one in five Americans experiences some form of mental illness, and the pandemic has greatly escalated their symptoms. As Dr. Song stated, “In my psychiatry practice, some of my college-aged patients who were previously able to manage their depression and anxiety are crippled in paralyzing fear of going outside, or depressed about the loss of their year and uncertain of their future.”
The Guidance Center’s seamless transition from in-person to virtual practice has made a significant difference for our families. When all feels like it is being lost with the limits that the shutdown has exacted, being able to maintain the routine of mental health counseling was a great relief. Parents have expressed gratitude for the continuity and for knowing that we have not abandoned them.
Of course, we can only do what we are doing because we have the technology to do so. And, as Dr. Song affirmed, “Prior to the pandemic, telehealth was not always covered by insurance; restrictions have temporarily been lifted for many, but need to continue post-pandemic.”
At the same time the nation’s mental health is declining due to the pandemic, the number of mental health professionals accepting insurance—and particularly psychiatrists—remains low due to the substandard rates of reimbursement that health insurers pay.
Federal mental health parity law demands universal access to care, yet health insurers rarely comply by providing adequate networks of providers, and government does not adequately enforce this law.
During this uncertain time, now more than ever we need to ensure universal access to care in order to flatten the mental health curve for our children and families.
Andrew Malekoff is the executive director of North Shore Child & Family Guidance Center, the leading children’s mental health agency on Long Island. The Guidance Center is seeing new and existing clients via telephone and video during the COVID-19 crisis. To make an appointment, call (516) 626-1971. Visit www.northshorechildguidance.org for more information.
