Tagged Computers and the Internet

Team Molly: The Family After Molly Steinsapir's Death

The Story of ‘Team Molly’

While her daughter was hospitalized, one mother built more room for our national grief.

  • Feb. 21, 2021, 5:00 a.m. ET
Molly and Kaye Steinsapir, in a photo provided by the family.
Molly and Kaye Steinsapir, in a photo provided by the family.Credit…Holly Gable

Strapped in the front seat of an ambulance as her daughter lay injured in the back, Kaye Steinsapir took out her phone and began to type.

“Please. Please. Please,” she wrote in part. “Everyone PRAY for my daughter Molly. She has been in an accident and suffered a brain trauma.” Later that day, at Ronald Reagan UCLA Medical Center, she tweeted her message.

Her daughter, 12, was injured while riding her bicycle with a friend near the family’s home in Los Angeles. Ms. Steinsapir, 43, said she was grasping for a tool that could quickly get her plea to as wide an audience as possible.

“I was so helpless,” she said in an interview on Thursday. “I just wanted to broadcast to anyone who could lift Molly up in prayer and could lift me up in prayer, too.”

The hospital’s Covid-era rules initially prevented her and her husband, Jonathan Steinsapir, from being at Molly’s bedside together. The first day of the hospitalization, Mr. Steinsapir spent the days with their two sons at home, while Ms. Steinsapir remained with their daughter in the intensive care unit.

“In the hospital, there were so many hours of waiting, waiting, waiting, and nothing to be done,” she said. In the darkest moments of panic or uncertainty, she reached out on the internet. “So many people shared stories of survival from traumatic brain injury,” said Ms. Steinsapir, who is a lawyer, as is her husband.

“The hope that all these strangers gave us was what sustained us. If we didn’t have that hope, I don’t know how we would have been able to do what we needed to do, to parent Molly and parent our boys,” she said.

Ms. Steinsapir, her husband, Jonathan Steinsapir, and their three children pictured in front of their home in Los Angeles.Credit…Robin Aronson

She didn’t have much experience on Twitter. Like many parents, she had shared family photographs to a small circle on Facebook and Instagram but in the months before the most recent presidential election, she began to spend more time on Twitter, following news sources and politicians. She barely knew how to tweet.

In turning to her phone to express her determination, anguish and fear, it never occurred to her that she would begin a 16-day-long conversation between thousands of strangers from around the world about life, death, family, religion and ritual.

Alana Nichols, a doctor and lawyer in Birmingham, Ala., checked in on Ms. Steinsapir every day. “As a mother, I was drawn to her vulnerability and her strength, and how she managed to turn Twitter into a positive tool of connection and hope,” she said.

This year, Dr. Nichols said, the election, reactions to the most recent Black Lives Matter movement and the pandemic have turned the internet into a marketplace of anger and vitriol.

“Social media can be so toxic and the doomscrolling phenomenon can put you in this place of total helplessness,” she said. “But Kaye gave us a way to help. She told us we could pray for her and her daughter. Our nation is divided on every big thing happening right now and here it is you have yet another tragedy — but it has had the opposite effect.”

The coronavirus pandemic has left Americans grappling with the colliding forces of isolation and grief, with technology and social media becoming further entangled with the rituals of death. Covid goodbyes are routinely said via FaceTime, with hospital staff using phones and tablets to help family members approximate bedside vigils and final goodbyes.

The Broadway actor Nick Cordero became sick from coronavirus in March and was hospitalized for months before he died in July. Amanda Kloots, his wife, attracted a global online audience of millions that prayed, sang, exalted and ultimately mourned with her. “I just wanted to share because grief is important to talk about, especially at a time right now where a lot of people are suffering from loss,” she said in one video.

Later last year, the model and actress Chrissy Teigen created a national dialogue about our culture’s comfort with public sharing of death and tragedy when she posted on Instagram hospital photographs taken of her, her husband John Legend, and their baby Jack, who was born prematurely and died.

“I cannot express how little I care that you hate the photos,” Ms. Teigen wrote in an essay later that month. “How little I care that it’s something you wouldn’t have done. I lived it, I chose to do it, and more than anything, these photos aren’t for anyone but the people who have lived this or are curious enough to wonder what something like this is like. These photos are only for the people who need them.”

Laurie Kilmartin, a writer for “Conan,” live-tweeted her mother’s last days before she died from complications of coronavirus in June. Ms. Kilmartin had tweeted about her father’s deterioration and death from lung cancer in 2014 and felt even more an impetus to do so as her mother was dying, because of the combination of grief and isolation. “What’s so awful about Covid is you’re completely alone,” she said. “All you have is your phone.”

Ms. Kilmartin followed Ms. Steinsapir’s story on Twitter and understood, from her own experiences, the desire to share in real time. “In a normal situation there would be 20 family members rotating in to support her and her husband,” Ms. Kilmartin said. “I’m glad she had the internet to hold her hand.”

Ms. Steinsapir also explained to her followers why she was letting strangers in on the experience. “Writing and sharing my pain helps to lessen it,” she wrote. “When I’m sitting here in this sterile room hour after hour, your messages of hope make me feel less alone. Even my husband, who is very private, likes reading them.”

In what became a short-form diary, Ms. Steinsapir provided unvarnished description of the realities of witnessing a medical crisis, marked by endless hours of waiting for her daughter to wake up that are then punctured by sudden calamity.

She heaped praise on her daughter’s doctors and nurses, worried about her two young sons, Nate and Eli, and told the internet all about her daughter, an environmentalist and animal lover who chose to be a vegetarian before she was in kindergarten, who was devoted to Judaism and feminism (she used “she/her” pronouns for God) and who dreamed of being a theater actress and a politician.

Like Ms. Teigen, Ms. Steinsapir pushed back against people who criticized her. “Believe me, I wish I were doing anything but desperately begging for prayers to save my daughter on Twitter,” she replied.

But mostly she called for support through prayers. The focus on God was part of what drew Melissa Jones, a mother in Locust Grove, Ga., to read each tweet and reply, even befriending others who were following closely.

“The faith she had hit me,” said Ms. Jones, who cried when speaking about a family she said she has come to love. “The internet right now is a horrible place, the Trump years were very divisive and people have been just so ugly for the last four years, but Molly’s spirit brought out the faith and the goodness in people.”

Ms. Jones had also faced the possibility of losing a child, when her son was critically injured. “My son was in a coma for 11 days and I had that experience of wondering, ‘Is my child going to wake up and am I going to have them back? I knew exactly where Kaye was,” she said.

On Feb. 15, Ms. Steinsapir announced that Molly had died.

“While our hearts are broken in a way that feels like they can never be mended, we take comfort knowing that Molly’s 12 years were filled with love and joy. We are immensely blessed to be her parents,” she wrote.

She agreed to speak to a reporter amid her family’s mourning, she said, because Molly would want her to console the millions of Americans who have lost loved ones in the last year.

“I want to communicate to people that we honor everyone who is grieving and want to share with them the light and love that was shown to Molly,” she said.

Remote Learning Isn’t Just for Kids

Remote Learning Isn’t Just for Kids

New online tools and an array of remote classes and programs are ramping up education and training for adults.

Credit…James Yang

  • Feb. 9, 2021, 5:00 a.m. ET

This article is part of our new series, Currents, which examines how rapid advances in technology are transforming our lives.

Deb Livingston, a former business consultant, was always curious and eager to learn just about anything.

“When the pandemic hit, I was confined at home and found myself diving into online exploration,” said Ms. Livingston, 61. She discovered GetSetUp, an interactive website that delivers virtual education to older adults.

Even former chief executives like Jeff Mihm, a Miami resident who led Noven Pharmaceuticals, sometimes need a new life direction.

After resigning from his corporate post, Mr. Mihm, 55, decided to go back to school — virtually, because of the pandemic — and enrolled in the University of Texas’s Tower Fellows program in September. “I have a love of learning, and it was an opportunity to step back, study and explore,” he said.

The internet has empowered adult learners by providing new online tools to ramp up education and training. “The need for workers to keep pace with fast-moving economic, cultural and technological changes, combined with longer careers, will add up to great swaths of adults who need to learn more than generations past — and faster than ever,” said Luke Yoquinto, a research associate at the M.I.T. AgeLab and co-author of “Grasp: The Science Transforming How We Learn.”

By 2034, the number of adults age 65 and older will outnumber those under the age of 18, according to the Census Bureau. “That growth of older age demographics will translate to new demand for enrichment in the form of digital education,” Mr. Yoquinto said. “I would say that, for both good and ill, older demographics are going to serve as a proving ground for learning technologies in the coming years.”

Adult education, however, is “the Wild West” of education technology, according to Mr. Yoquinto. There are many outlets experimenting with ways to get a handle on the online adult education marketplace, including community colleges and universities, for-profit learning platforms, workshop providers and nonprofit organizations.

The new platforms are also opening doors to more adults. “There are already tons of people who, once upon a time, by dint of age or circumstance, wouldn’t traditionally have gotten the chance to partake in education, but can now sign up for free online courses,” Mr. Yoquinto said. Participants can choose a class here and there, without strapping on a backpack and heading to campus or signing up for expensive degree programs.

Virtual learning has become “the great equalizer,” said Gene O’Neill, the chief executive of the North American Veterinary Community, which provides continuing education for veterinarians around the world. “Because of virtual learning, veterinary professionals everywhere, even in remote, undeveloped countries, can learn from the world’s most renowned leaders and virtually participate in conferences,” he said. “This puts learning on an equal platform for everyone regardless of geography, income or time constraints.”

Ms. Livingston’s goal was to improve her skills so she could become a paid teacher on the GetSetUp platform, which offers classes — all taught via Zoom by teachers older than 50 — on skills from professional development to technology, health, wellness and hobbies like photography. There’s even a new class about registering for a Covid-19 vaccine, given the difficulties many people have faced. There are three membership levels, starting at free and topping out at $20 a month for unlimited access.

“The nature of work is changing,” said Neil Dsouza, GetSetUp’s chief executive and co-founder. “The traditional way of designing training and reskilling is a long, drawn-out program where you get a certificate or a degree. By the time you get that certificate, the skill is already outdated. We’re changing that model.”

Ms. Livingston, who lives in York, Pa., signed up to learn how to use Zoom to host classes, how to manage and lead an online class and how to teach Google Classrooms. “Seniors everywhere were in lockdown and were eager to learn and connect,” she said.

Because she’s interested in cooking and eating healthy meals, Ms. Livingston eventually began teaching classes such as “Great Dinners in 30 Minutes or Less,” “Healthy Eating on a Budget” and “Healthy Desserts That Are Delicious, Too.”

In January, Oasis, a nonprofit educational organization, launched Oasis Everywhere, with a menu of online classes on subjects from art to writing. Senior Planet, a unit of Older Adults Technology Services, or OATS, is a nonprofit resource for people 60 and older that offers courses and lectures.

OATS was founded in 2004 in New York City as a community-based project for older adults focused on tech education. Since then, it has expanded to over 200 locations in five states, serving urban and rural communities. But last year it was forced to pivot in response to the pandemic. “We taught hundreds of in-person classes before the virus forced the closure of Senior Planet locations in March,” said Tom Kamber, the founder and executive director.

That’s when his team pulled together and, within weeks, launched a fully digital set of courses and programs that have rapidly expanded its reach to its primary audience — a global community of anyone 60 and older.

Beyond Senior Planet, OATS launched Aging Connected, which aims to get one million older adults online. It provides tablets, along with training and technical support, to 10,000 older residents of New York City Housing Authority communities.

“I really wanted to create a program that would be able to get older adults to use technology and give them the kinds of training and support in environments where they could succeed,” Mr. Kamber said.

While older adults are continuing to learn new skills, they also are starting new businesses. In 2019, research from the Kauffman Foundation, a nonpartisan group supporting entrepreneurship, found that more than 25 percent of new entrepreneurs were ages 55 to 64, up from about 15 percent in 1996.

Online courses are riding that start-up wave. GetSetUp, for example, offers courses on running an e-commerce marketplace, starting a business from home and building a website.

Other offerings for entrepreneurs include Blissen, a three-month virtual boot camp for entrepreneurs over 50, and the AARP Foundation’s Work for Yourself @50+, which offers free webinars and workshops.

But all these online opportunities are not possible without access to the internet. “While there’s a rising passion for knowledge, people are getting excluded from the educational process in this country because they’re not online,” Mr. Kamber said. Based on a research report OATS recently released in partnership with the Humana Foundation, nearly 22 million Americans over the age of 65 lack broadband access at home.

“The good news, though, is the level of sophistication of online education is increasing and more access is coming to rural communities,” Mr. Kamber said. “It’s a brave new world of learning for people, and that gives me hope.”

For Ms. Livingston, that means continuing to take and teach classes at GetSetUp.

“Learning at any stage of life is what stimulates creativity and joy,” she said. “So much energy emerges from connecting the dots, having ‘aha’ moments and gaining skills. I love that I can help others keep their zest for life and help myself in the process.”

I’m a Disabled Parent. It Took a Pandemic to Let Me Join the P.T.A.

I’m a Disabled Parent. It Took a Pandemic to Let Me Join the P.T.A.

My chronic illness made it hard to volunteer at my kids’ school. Now I can serve on the executive board of the P.T.A. without leaving my bed.

Credit…Jialun Deng

  • Feb. 2, 2021, 5:00 a.m. ET

In a year of intense isolation, I’ve never felt more connection to my children’s school.

I have a chronic illness that has kept me from volunteering in the highly engaged P.T.A. at my children’s New York City public school. In a strange paradox, for many chronically ill parents like me, the pandemic has brought new opportunities to become substantially involved in our children’s lives and schools.

With a background in teaching and educational reform, I’d spent most of my life in classrooms. I’d always assumed I’d be an active participant in my two children’s learning. Initially, I was — when my first child was 2, I created a cooperative playgroup and later joined a more established group, where I served on the admissions committee. Then, when my older child entered pre-K, I got sick.

I went from a vibrant, engaged woman to a person who clung to her home, and often her bed, as if it were a life raft. Some mornings, despite 10 hours of sleep, I’d wake plagued by dizziness, feeling like I’d been hit by a truck. Eventually I was diagnosed with myalgic encephalomyelitis (M.E.), more commonly known as chronic fatigue syndrome, a disease that impacts between 836,000 and 2.5 million Americans, with women being afflicted at four times the rate of men, leaving the most severely ill completely bed-bound.

The first few years of my illness were the most challenging. On good days, I could muddle through short family events in my children’s classrooms, but on bad days it took everything in me to drag myself one block to after-school pickup, timing the trek so I’d have to wait a minimal time at the gate. Volunteering was out of the question.

In addition to frequent meetings, the P.T.A. at my kids’ school holds numerous social and fund-raising events. I couldn’t even muster the energy to attend these as a participant, let alone assist in organizing. The annual P.T.A. board elections were a difficult reminder that though I had much to contribute, my illness kept me from getting involved.

Last spring, when the world went online in the pandemic, my children’s school, like so many, did its best to pivot. But even with the commitment and energy of the school community, I’d be hard pressed to say it thrived. I knew the P.T.A. was going to be heavily involved in plans for the fall, so I reached out to see if I could help. There were conversations about everything from the flipped classroom model to improving the feedback loop between frustrated parents and overwhelmed teachers. Brainstorming solutions lit me up.

In the fall, the P.T.A. presidents asked if I’d consider joining the executive board as co-vice president of publicity and communications, teaming up with another parent I liked and respected. The P.T.A. leaders told me they had a new vision for the organization. In addition to the ubiquitous fund-raising, they wanted a major push toward improving communications and building community in a landscape that made both challenging. The new mission, the role and working with the other parent appealed to me. Still, I wavered.

One of the cardinal symptoms of M.E. is post-exertional malaise, where physical and cognitive effort leads to a flare-up. Pacing, or monitoring energy expenditure, is a critical part of symptom management. While the severity of my illness had decreased through a combination of treatment, pacing and luck (that summer I’d even been swimming with my kids and on a few short hikes), I worried that overcommitting could catapult me back. But because I could do everything virtually from my house, even from my bed if need be, I took a chance and said yes.

Since October my co-vice president and I have collaborated on our school newsletter, planned a social-justice movie night, and after the chat in one P.T.A. meeting became problematic, helped develop procedures for more effective communication during virtual meetings. In addition, we’re serving as liaisons between a parent-led advocacy group, school administration, and an external group that will be providing training to teachers and parents on how to more effectively address issues of race and racism both at home and at school.

I am not alone in appreciating this unexpected silver lining of the pandemic. In an online group for parents with M.E., run by the #ME Action Network, I encountered several other parents who also credit Zoom for allowing them access to their children’s school in a new way. For Holly Latham, from Jackson, Tenn., who self-describes as “barely hanging on by my fingernails,” it was as basic as being able to attend a meeting virtually to discuss an individualized education program, or I.E.P., for her child who has special needs, instead of struggling to get there physically.

Before the pandemic, Marthe Schmitt, a 51-year-old mother of one from St. Louis, Mo., wished to be more involved in her 8-year-old daughter’s school, but couldn’t: “I was always hesitant to commit to something and then not be able to physically show up.” This year though, she dove in, serving as social-media coordinator and working with her husband to update the school’s bylaws and make them more inclusive. “M.E.’s a very isolating disease, but being on the board has made me feel more connected and less disenfranchised,” Ms. Schmitt said.

Elin Daniel, a 42-year-old mother of one from Bothell, Wash., has moderately severe M.E. and is able to leave the house only a few times a week. “When school was in-person, just getting ready to attend an event would exhaust me and I’d always have a flare-up a day or two after,” she said. But since her children’s school went virtual, she’s joined her P.T.A. board as fund-raising chair, which has improved her mood and self-esteem. “I so rarely feel useful,” Ms. Daniel said. “It feels nice to contribute to the community and set an example for my daughter.”

For parents with chronic illnesses, the ability to be involved in our children’s lives isn’t something we take for granted. Mary Wu, a 41-year-old former teacher from Los Angeles and mother of three, only recently became ill but feels this deeply. Before her diagnosis, she and her 15-year-old daughter had been involved with National Charity League, an organization dedicated to leadership development and philanthropic work such as volunteering at food banks, cleaning up beaches and providing healthy snacks to underfunded schools.

“It was a great way to spend time with my daughter while teaching her to give back,” Ms. Wu said. “But after the onset of my illness, there’s no way I could have done it in person anymore.” Luckily, the charity league’s pivot to online meetings and virtual service has allowed the Wus to continue, fulfilling some of their service hours by sewing face masks for a local organization dedicated to helping women with breast cancer.

“I want something positive to come from all this,” Ms. Wu said. “I hope in the future, organizations still provide access to parents that can’t be there physically.”

Heather Osterman-Davis is a writer, filmmaker and mother of two in New York City.

Zoom Funeral Tips

How to Hold a Virtual Memorial Service

A virtual memorial offers several advantages: It’s easy for distant guests to attend, and you can record it.

Credit…Derek Abella

  • Jan. 14, 2021, 5:00 a.m. ET

When my 80-year-old father recently died, coronavirus restrictions meant that our family, like many others, could not safely gather for a funeral. My mother, brother and sister-in-law in New York, along with me in Berkeley, Calif., hastily organized a memorial service on Zoom.

What could have been a disaster or fodder for an episode of “Curb Your Enthusiasm” ended up being incredibly moving. Rather than diminishing the experience or getting in the way, videoconferencing facilitated an event filled with emotion, humor and love. During a difficult time for our family — in a devastating year for the entire world — that was an unexpected blessing.

Despite our fatigue with remote work meetings, we all were struck by how well-suited it turned out to be for a memorial.

Families who are opting for video memorials are probably doing so because of pandemic restrictions limiting the number of people who can attend an indoor gathering. Since you can join a virtual event from anywhere — and with minimal planning — more people are likely to attend than if they needed to travel to an in-person event.

In our case, the immediate family was on both coasts, one grandchild was in Scottsdale, Ariz., and the rabbi, Jeff Salkin of Temple Israel West Palm Beach, a longtime friend and former student of my dad, was in Florida.

With a videoconferencing service, you can style your memorial as you like. While we did not include photos, videos or music, nothing prevents you from doing so. In addition, a virtual memorial costs much less than an in-person event, where you’d have to pay for the brick-and-mortar venue and perhaps catered food. And you can easily record the event to share and save for posterity.

A virtual memorial also might accommodate more speakers than an in-person event. Ours began with moving eulogies by Rabbi Salkin, followed by my brother and me, then morphed into an impromptu shiva, as numerous guests offered wonderful remembrances and reflections about my dad. The event lasted two and a half hours; many people remained the entire time.

My father’s was not Rabbi Salkin’s first Zoom memorial service. He was skeptical before he led a Zoom gathering after his stepmother died of Covid-19 in April.

“I feared that such funerals would be alienating,” he said. “I was wrong. Wi-Fi carries the love quite effectively. In person, you can hold people’s hands and embrace them. On Zoom, it’s more about holding people’s eyes and simply being with them, in every way that matters.”

At the beginning of lockdown, Zoom ran into security issues. As the technology writer Brian X. Chen detailed in a column in April, weak privacy protections resulted in uninvited “Zoombombers” crashing meetings in embarrassing fashion.

That happened when my kids’ school district started distance learning: A nude man entered a virtual class and used racial slurs. It was a lesson for our family to be sure our event was password protected.

Even Jonathan Leitschuh, a software engineer and security researcher who identified flaws in Zoom’s security protocols that allowed hackers to take over Mac users’ webcams in 2019, turned to Zoom to plan a funeral for his mother who died in April.

“I went in terrified about a Zoombombing,” Mr. Leitschuh said. “I’d seen the same media coverage everyone else did.” But he said: “For this use case, I wasn’t aware of a better platform.”

There are several alternatives to Zoom, including Google Meet, Skype and GoTo Meeting, which may offer enhanced security protections and come with their own inherent trade-offs.

Funeral homes are also offering livestreamed services, in conjunction with limited in-person memorials. Chris Robinson, a fourth-generation funeral director in Easley, S.C., and spokesman for the National Funeral Directors Association, said his funeral home has been livestreaming services via its website, allowing anyone to attend without the need to download software or register for a videoconferencing platform.

“It’s important to go ahead and put together a virtual service,” he said, “rather than wait until the pandemic is over, because it could be a long time, and delaying indefinitely can be an ongoing trauma.”

In my family’s case, we were truly impressed by how videoconferencing, which can be so enervating in our daily work lives, enabled us to celebrate my dad’s full life in a beautiful and moving way.

If you have to arrange a memorial service on a video platform, here are some tips.

Go Pro

We purchased a one-month subscription to Zoom Pro (right now it’s $14.99 a month and you can cancel at any time). It allows for up to 100 participants (other plans allow for more, at additional cost), with unlimited meeting time, and stores a recording in the cloud. We’re glad we did. If we had had to limit the time of the event, we would have missed many moving contributions from participants.

Identify Someone to Handle Logistics

Because I created the account, I was the de facto meeting host. In hindsight I wish I had handed the role to my 17-year-old daughter, a digital native. Responsibilities include admitting people from the waiting room; muting all mics as appropriate; unmuting the officiant or other speakers; troubleshooting technical issues; providing assistance to guests; and passing messages along to family members in the chat box. Introduce the tech host at the beginning of the service, so people know whom to contact for help.

Familiarize Yourself With Platform Settings

The back end of video platforms have settings that can be tricky if you are new to them, especially if it is an emotional event. The host can go through the “toggle” switches in advance to figure out how to mute people upon entry or enable the waiting room, a security feature that keeps guests in a queue until the host admits them.

Who Will Lead?

Our virtual memorial succeeded, in part, because the rabbi wasn’t thrown off by the difficulties inexperienced Zoomers had muting themselves at the start. When the service segued into the shiva, my mother moderated — greeting people and making sure everyone who wanted to offer a remembrance had the chance to do so.

Plan a Dry Run to Anticipate Issues

Schedule one or more short practice sessions to work out kinks and make sure you’re on the same page about various roles. Some participants at our event were complete Zoom novices, fearful of missing the eulogy, and self-conscious about holding up the program as they attempted to mute as requested. We recommend offering tips to guests about logging on and off; muting and unmuting; switching screen views; and using the chat function — either along with the invitation, or on request ahead of the event. Don’t assume that everyone will be joining with up-to-date devices.


We sent an email to notify friends and relatives of my dad’s death and of the Zoom event, including a link and password. Each of our family members compiled and distributed our own lists. You can also use Zoom to send email invitations.

You’re on TV (Sort of)

Without being obsessive, think about your on-screen appearance, makeup, lighting, camera height and angle and backdrop.

Beware of Tech Gremlins

While we were spared technical disruptions, the specter lurked in our minds. Many parts of the country experienced power outages this summer, and we’ve all had our internet connections go down or struggled with microphones and screens that freeze at just the wrong time. Although impossible to predict, be mindful of what could go wrong and how you’d handle it.

Ultimately, you want to make sure the virtual event accomplishes the same things an in-person funeral or memorial service would, honoring the life of the deceased and comforting the survivors. As it turned out, many more of my parents’ circle — friends and family in their 70s and 80s — were able to attend the funeral than would have been able to, even without Covid restrictions. Likewise, more people spoke than would have stepped to the lectern at an in-person funeral service. And the video we have is a blessing, which will enable my family to keep my father’s memory alive and hold on to vivid memories of those who so loved him.

Steven Birenbaum is senior communications officer at the California Health Care Foundation in Oakland, Calif.

Working From Bed Is Actually Great

Working From Bed Is Actually Great

A perfect metaphor for a year of giving up and giving in.

Credit…Photo Illustration by Justin J Wee for The New York Times
Taylor Lorenz

  • Dec. 31, 2020, 3:00 a.m. ET

For years, sleep experts have held one piece of common wisdom above all else: that devices have no place in the bedroom.

Yet since the pandemic began in March, millions of Americans have defied that guidance and begun working precisely where they sleep. They are drafting legal documents, producing events, holding client calls, coding, emailing, studying and writing, all from under the covers.

This wasn’t always the plan. Early on, many of them invested in desks and other equipment meant to make their homes as ergonomically sound and office-like as possible.

When New York City shut down in March, Vanessa Anderson, 24, set up a small desk for herself in her living room. She was working for an agency that manages private chefs and wanted to keep some semblance of separation between work and sleep. “For a while I was really committed to not working from my bedroom at all,” she said.

In May, Ms. Anderson moved her desk into her bedroom for more light. “My bed was just sitting there, taunting me,” she said. She set ground rules for herself: She’d only get in bed after 2 p.m., but that start time shifted earlier and earlier. Come July, her bed had become her full-time office.

Ms. Anderson has since switched jobs — she works in e-commerce for a spice shop now — and only works remotely part of the week, but still from bed. Talking to others, she’s discovered how commonplace the practice is. “I’ve been on calls with people where we were both in bed,” she said. At the end of the call it’s like, ‘How’s the pandemic going? Oh, you’re in bed right now too? So am I!’”

Working from bed is a time-honored tradition upheld by some of history’s most accomplished figures. Frida Kahlo painted masterpieces from her canopy bed. Winston Churchill, a notorious late riser even during World War II, dictated to typists while breakfasting in bed. Edith Wharton, William Wordsworth and Marcel Proust drafted prose and verse from their beds. “I am a completely horizontal author,” Truman Capote told The Paris Review in 1957. “I can’t think unless I’m lying down.”

Along with fueling creative thinking, the bedroom can be a refuge from the chaos of home life. Parents retreat there to hide from their homebound children. Others are fleeing roommates.

“I think one of the things we’re learning is that we’re all in tight places figuratively and literally, especially if you have a roommate or spouse, there just isn’t enough real estate in your home to have the privacy to get your work done,” said Sam Stephens, 35, a singer and songwriter in Nashville.

Working from bed may also be symptomatic of collective malaise. “I spend way more time working from bed even though I have a computer, office chair and desk,” said Abelina Rios, 26, a YouTuber in Los Angeles. “I think everybody is feeling depressed from the pandemic, and when you’re depressed one of the harder things to do is to get out of bed.”

Plenty of people, though, are unabashed about their choice to stay in bed all day. Poulomi Banerjee, 26, a fund-raiser in Maryland, said that she’s worked this way since middle school. “I was unable to focus unless I was super comfortable,” she said.

Daniel Peters, 45, a marketer in San Francisco, specifically works on his wife’s side of the bed during the day. (Because sleep hygiene?) He posited that working from bed could be an expression of denial. “I wonder if we almost subconsciously don’t accept this is real life,” he said. “Does sitting at a table or desk make it feel more like real life? We all felt like this pandemic would only take so long and it’s still going on. If I sit at my desk all day, does that mean this is how it is going to be full time?”

Credit…Photo Illustration by Justin J Wee for The New York Times

Liz Fosslien, 33, an author of “No Hard Feelings,” a book about how emotions affect work, brings her computer into bed with her every morning, wireless mouse and all. “I use my mattress as a mouse pad,” she said. Her advice to anyone doing the same these days: “Don’t beat yourself up for it. It is easy to be like, ‘Ugh I’m in my pajamas, I haven’t washed my hair, what am I doing,’ but it’s really about the quality of your output.”

A primary argument against using devices in bed is that it can further erode the boundaries between work and home, and disrupt your sleep cycle. But even Arianna Huffington, the media executive turned sleep evangelist, has found herself working from bed since the pandemic hit.

“I think it can work great for people, but it’s critical to have certain boundaries,” she said. Ms. Huffington suggests keeping your night stand clear of clutter and ensuring that you have a hard stop on work hours where you get out of bed and store your electronics in another room.

“I highly recommend a real transition,” she said. “I have a hot shower and bath to wash away the day, change what you’re wearing, have a different T-shirt for sleep. I love beautiful lingerie. It makes you feel like, ‘Hey, you’re going to sleep.’”

Proponents of desk culture have argued that there’s no way someone can be productive from bed. “I don’t know anyone who works actually in a prone position, but I know tons of people who work in bed (my husband, for instance). I think they’re all a bunch of lazy, bedsore-prone, rapidly deteriorating slobs,” the writer Susan Orlean told The New Republic in 2013. “Or maybe they’re much, much happier (and smarter) than the rest of us.”

But what many homebound workers are realizing during the pandemic is something chronically ill and disabled people have known for years, that working from bed doesn’t mean you’re lazy or depressed. In fact, it’s perfectly possible to hold down a job remotely from bed, provided your employer is flexible about remote work.

“We have data showing time crafting is good for happiness, if you’re able to work from anywhere and you choose to work from bed this is one example of time crafting,” said Ashley Whillans, an assistant professor at Harvard Business School. “Picking where to work and how to get work done can improve employee satisfaction.”

Tessa Miller, 32, the author of the book “What Doesn’t Kill You,” about her struggles with chronic illness, has been working from bed since she was diagnosed with Crohn’s disease at 23. “I think that the pandemic is highlighting all these things that chronically ill and disabled people have been doing for a long time, and now everyone is doing them as well and working from bed is one of them,” she said. “I know a lot of highly productive, intelligent, talented people who have to work from bed as a necessity.”

Those with chronic illness or disabilities say that they hope that, much as the way the pandemic has made companies more open to remote work, the stigma around working from bed will also be broken. “I hope one of the things that come out of this is it reveals you can still do good work from your bed, or bathtub, or living room sofa with a heating pad and I hope that will create opportunities for people who are chronically ill or disabled n fields they maybe didn’t feel welcome in before,” Ms. Miller said.

Amy Patel, 34, a product manager for a life sciences software company in Austin, was forced to work from bed in the early months of the pandemic when she was placed on bed rest during her pregnancy with twins. She did not love it. However, proper gear helped. “My husband bought me a really nice desk that you could put your laptop with a mouse on,” she said. “I did everything on there.”

If you want to replicate the feeling of working in bed without actually being in bed, you could purchase an Ergoquest Zero Gravity Workstation for $5,995 or buy one of the many, much cheaper computer mounts made for reclining in bed. Supportive pillows are also key for avoiding back pain. Having a spill-proof cup or a mug with a lid helps too, as some have learned the hard way.

While some people turn on computerized backgrounds to avoid revealing their bedroom workstations on video calls, others have embraced their cozy surroundings. Ms. Stephens said that she’s decorated the wall behind her bed with children’s artwork to make a more engaging background for her Instagram Live performances.

Abie Sidell, 27, a filmmaker in New York, often works from bed because of his chronic illness, but he has found it helpful even when he’s not having a flare-up. “I think that being horizontal is conducive to creative thinking,” he said. “When we’re horizontal, whether it’s sleeping or dreaming, is when we’re doing a lot of subconscious or unconscious creative work.”

If Mr. Sidell is stuck on a project or needs to think, he’ll go lie down. “Being in bed is great,” he said. “I wish, in general, there were fewer norms and standards around where it is and isn’t acceptable to work.”

If this year doesn’t shatter them, what will?

Amazon Halo Review: The Fitness Gadget We Don’t Deserve or Need

tech fix

Amazon Halo Review: The Fitness Gadget We Don’t Deserve or Need

The retail giant claims that its health product is extremely precise at scanning body fat. I found otherwise.

Credit…Glenn Harvey
Brian X. Chen


  • Dec. 9, 2020, 5:00 a.m. ET

Many of us are in the same boat these days. With the coronavirus killing more people by the day, we are increasingly stress-eating and drinking more alcohol. At the same time, with gyms shut down, we are sitting around more and glued to screens.

So you may be wondering what I’m wondering: How is the pandemic affecting my body? Because we can’t easily leave the house to see doctors for nonemergencies, we are largely left to figure this out on our own.

Enter the Halo, a new fitness-tracking bracelet from Amazon with a novel twist: It claims that by using a smartphone app to scan images of your body, it can tell you how much body fat you have much more precisely than past technologies. The bracelet also has a microphone to listen to your tone of voice and tell you how your mood sounds to other people. (The masochist inside me said, “Sign me up!”)

The Halo is Amazon’s foray into so-called wearable computers that keep an eye on our health, following in the footsteps of Apple and Fitbit. Amazon is selling the Halo for $65 on an invitation-only basis, meaning you have to get on a waiting list to buy it. I volunteered to be a guinea pig and received mine in October.

When the Halo arrived, I installed the app, removed my T-shirt and propped up my phone camera. Here’s what happened next: The Halo said I was fatter than I thought — with 25 percent body fat, which the app said was “too high.”

I was skeptical. I’m a relatively slim person who has put on two pounds since last year. I usually cook healthy meals and do light exercises outdoors. My clothes still fit.

I felt body-shamed and confused by the Halo. So I sent my Halo data and body scans to Dr. Lawrence Cheskin, a professor of nutrition and food studies at George Mason University and founder of the Johns Hopkins Weight Management Center.

After reviewing my results, Dr. Cheskin jotted down my height and weight to calculate my body mass index, which is a metric used to estimate obesity. A man my age (36) with my body mass index, he said, is highly unlikely to have 25 percent body fat.

“Unless you were a couch potato and ate a very poor diet, I have my doubts about the Halo’s diagnosis,” he said.

Dr. Cheskin encouraged me to gather more data by measuring my body fat with other devices, and to do the same with at least one other person. So I did and found that the Halo’s body fat readings consistently skewed higher than other tools for myself and my test subject.

I concluded that the Halo’s body analysis was questionable. More important, it felt like a negative experience that failed to motivate me to get fit. I’ve had much more uplifting experiences with other products like the Apple Watch and Fitbit bands, as laid out below.

Measuring Body Fat

The Amazon Halo bracelet and app.
The Amazon Halo bracelet and app.Credit…Amazon

Body fat measurement can be complicated because the traditional methods available to consumers are not always accurate.

Smart bathroom scales that measure body fat use bioelectrical impedance analysis, which sends a small current through your bare feet. Skin calipers, a more dated method, are essentially rulers that pinch down on skin folds to measure thickness.

These techniques are not perfectly reliable. If people step on smart scales at different times of day or with different levels of hydration, their results may vary. Calipers can measure skin folds incorrectly if you pinch in the wrong areas.

Amazon said the Halo’s technology was much more precise. To scan your body, you use the smartphone’s front-facing camera to take photos of your body from the front, sides and rear. Then Amazon stitches the images together into a 3-D model to analyze your body composition and calculate the percentage of fat.

I decided to record consistent body fat measurements for myself and a friend using the Halo, a Fitbit bathroom scale and a highly rated skin caliper. In November and December, I took early-morning measurements with the Halo and bathroom scale; my wife pinched my skin folds in four areas with the caliper. I measured my test subject’s body fat once with each device.

Our results were remarkably similar for two men with very different body compositions:

  • The Amazon product estimated that my friend, a 6-foot-3 man weighing 198 pounds, had 24 percent body fat, the Fitbit scale read 19 percent, and the skin-fold measurements added up to 20 percent.

  • For myself — 5-foot-6 and about 140 pounds — the Halo said in November that I had 25 percent body fat, the Fitbit scale said 19 percent, and the skin-fold measurements added up to 20 percent. In December, the Halo said I had 26 percent body fat (alas, I had more Thanksgiving leftovers than usual), the Fitbit scale said 20 percent, and the skin-fold measurements added up to 21 percent.

Dr. Cheskin speculated that the Halo might have an overestimating bias in its algorithm because underestimating body fat for an obese person would be more problematic.

Dr. Maulik Majmudar, Amazon’s medical officer, who worked on the Halo, said people should expect the device’s results to be different because the method was more accurate than body fat scales and calipers.

Amazon developed its body-measuring algorithm from a sample set of tens of thousands of images of people’s bodies from across a wide range of demographics, he said. Amazon then did internal tests measuring people’s body fat using the Halo scanner, smart bathroom scales and DEXA, a technique that uses X-rays to scan for bone density, which studies have found to be a reliable measure for body fat. It found that the Halo method was twice as accurate as bathroom scales.

Still, Dr. Cheskin was unconvinced by Amazon’s accuracy claims. He said a valid study would involve a clinical trial measuring body fat of many human subjects with each method — the Halo, DEXA, bioelectrical impedance scales and calipers — and comparing the results side by side.

Accurate or not, the most disappointing part of Amazon’s body fat analysis was that it lacked important context. Even though the app asked for my ethnicity, age and sex, it said my 25 percent body fat level was too high and well outside the “Healthy” zone (roughly 12 to 18 percent). It also said healthy results were associated with longer life and lower risks of heart disease.

Dr. Cheskin offered a more nuanced analysis. Body fat levels may have different health implications depending on your age, ethnicity, sex, cholesterol levels and family history. Waist circumference matters, too, because severe abdominal fat can be associated with health problems.

For an Asian man my age with a 34-inch waistline, whose family has not had a history of diabetes or heart problems, and whose blood tests recently showed normal cholesterol levels, even a 25 percent body fat reading would probably not be alarming, he said.

That context, combined with my body mass index along with the measurements taken with a body fat scale and caliper, led Dr. Cheskin to doubt Halo’s analysis.

He worried about the technology’s potential consequences.

“Does it potentially create eating disorders?” he said. “You’re taking a bunch of people with normal weight and B.M.I. and telling them they’re too fatty. What are they going to do with that? Some of them are going to be more compulsive and start doing things that are going to be inappropriate.”

Bottom Line

This experiment raised another question: What in the world was Amazon thinking releasing a product like this now? It has been impossible for us to move around as much as we used to this year. If anything, we should accept that our bodies will be imperfect during this time.

Dr. Majmudar said he felt the opposite. As a clinician, he said, he would encourage patients to mitigate the health risks of gaining weight and being more sedentary in the pandemic. The goal of the Halo was to drive behavioral change with education and awareness, he said.

“The desire or intention was never to body-shame people,” he added.

In my experience, there are better fitness-tracking products that offer more positive motivation.

The Apple Watch, for one, lets you set goals for how much you want to move or exercise each day, and those goals are symbolized by colorful rings that are shown on the watch face. Once a ring is completed, you have met your goal. Fitbit devices send notifications to your phone, egging you on when you are nearing your step goal. Neither device comes anywhere close to giving you body dysmorphia.

Another of Halo’s unique features is Tone, which uses the bracelet’s microphone to periodically eavesdrop on your conversations to tell you what your mood sounds like. I turned the feature off after two days because it felt like a creepy invasion of privacy. But I left it on long enough to complain to my wife about what a bad idea it was.

After analyzing the conversation, the Halo app said I sounded irritated and disgusted. That, at least, was accurate.

A Shifting View on Telemedicine

In March 2019, a robot entered a patient’s room in California and a doctor on its screen told him and his granddaughter that he was dying.

This experience, posted to the granddaughter’s Facebook page, was treated as a scandal. Newscasters questioned the humanity of a health care system that would do such a thing. Words like callous, heartless and cold were used to describe this apparent lack of compassion and care.

Bad news, it seemed, should be delivered only by compassionate individuals, with good communication skills, who are actually in the room with the patient. Not at a distance over a screen.

Just a year later, Covid-19 changed all that.

We had a highly contagious virus devouring hospital resources, a combination of factors that made hospitals inhospitable to families. Almost overnight, most American hospitals strictly limited visitation.

In the early days of the pandemic, some staff members could not ignore the human toll of isolation they were witnessing, and started using their own cellphones to connect patients with their families, if only for a few moments. This would never have happened pre-Covid, when fears of HIPAA violations and a mandate for personal privacy had always kept personal phones in pockets.

These virtual reunions were powerful and almost always positive — not only for the patient and family, but for staff. They brought humanity to days filled with stress and sadness.

And for the patient, alone in the hospital, the iPad on a stick represented not a cold robot but a portal to their loved ones. Where just last year, communication through a screen felt crass, all of a sudden, it became the only compassionate thing to do. Hospital teams expected families to be resistant, but we discovered receptivity and profound appreciation for the ability to connect, by whatever means available.

Before we all realized it, we had entered the era of tele-health — where instead of an iPad representing coldhearted indifference, it now symbolizes our human desire to connect and communicate. Just as we have found creative ways to continue to connect socially through life-cycle events — video cocktail hours, Netflix parties, Zoom weddings and funerals — we have realized that technology can provide so much more to the care of patients than we thought it could.

At the beginning of the pandemic, when I knew I would have to start interacting with families virtually, I was apprehensive. The hallmark of a palliative care team’s work has always been in-person, human connection. As facilitators of arguably the most difficult conversation topic of all — death — we literally lean into emotions that most people would run from. Unlike most medical interactions, we are not transactional, extracting a vial of blood, a signature on a consent form. Our service is to witness, reflect, and be truly present. We have been trained to provide a certain physicality, pulling up a chair, making eye contact, holding a hand. Could we really do that on a screen?

But our team had no choice, and having no choice can be clarifying. It was clear we needed to bring in the technology and at least try it. We received an emergency grant from the San Francisco-based Stupski Foundation and got to work, deploying 30 new iPads to various teams in the hospital so they would be able to access our services more readily.

The choreography of this experience varied, depending on the technology and staff available. The set up could sometimes feel like we were on a film set, the med student encased in PPE playing the role of camera operator, minus the professional training, holding the iPad shakily over the patient’s face as the Zoom panel looked on. Sometimes I was the person “bringing” others — family members, our chaplain, or our social worker — into the patient’s room on the rolling iPad. Other times I was “rolled” into the room, the virtual consultant, sitting on my couch, my poodle curled next to me.

I was working offsite for our first virtual encounter. The patient had Covid pneumonia and had been in the intensive care unit on a ventilator for weeks. The intern who consulted us warned us that his family was frantic, angry, calling incessantly in search of information. We arranged for all six siblings to join us in our “Zoom room” to meet with us, get a medical update, and see their father, intubated in the I.C.U.

I was surprised by how nervous I was, nervous that I didn’t know what I was doing, that I would be perceived as a fraud. “You’re not even with my father, right now?” I imagined his irate daughter saying to me as I fumbled with the technology.

Before the meeting started, I joined our chaplain and social worker in the “Zoom room” to strategize our approach to this uncharted virtual territory. Having worked together for a decade, we are adept at reading each other’s body language in person, but we knew this would be different, all of us facing forward in a grim Hollywood Squares. We anticipated it could so easily get out of control — family members grieving alone in their homes, anger brewing, even a Zoom-bomber, which I’d been hearing about. We devised a subtle hand signal so that we would be less likely to trip over each other during the video visit. “Ready?” I asked, before holding my breath and pressing “admit.”

To our surprise, it turned out to be less challenging than we expected, as did all the ones that followed. Any initial doubts I had about this medium were erased by the relief of families connecting in this desolate time. True, they didn’t have much of a choice, having been shut out of the hospitals. But their heartfelt appreciation of a physician’s presence was a striking contrast to the national sentiment expressed just 12 months earlier, where an iPad on a stick was seen as a cold robot. Now, it was perceived as a lifeline. One patient said to me as I hovered from home in one of the Zoom squares, “I don’t know who you are, but thank you for bringing my family here to be with me.”

Over the next few months we learned how to better translate our in-person presence to an online format. Where I would normally hug or touch a patient on their shoulder, now I put my hands over my heart. Instead of looking directly into their eyes, I made sure to always look directly into the green light of my computer’s video camera. I stayed quiet as the families wept and spoke to their unresponsive loved ones.

I discovered that I can be compassionate on and off the screen, which made me wonder: Is the most important factor for delivering excellent care physical proximity? Or is it depth of focus, and quality of communication? Is it dependent on technology or the person using the technology?

In this work I have discovered that telehealth is not merely a pale substitute for in-person care but rather a viable alternative, even offering some distinct advantages. It allows patients to see their loved ones from all over the world. It reduces the risk of exposure to Covid or other hospital-borne infections. It also allows us to preserve precious PPE for the primary teams who need it.

Telehealth has been in the background of health care for a while, primarily in rural communities where distance limits access. Now that Covid has pushed it into the mainstream, many more of us have seen and felt its benefits. Health care teams are grateful to have it available, and patients and families are not shocked when an iPad is rolled into a room or they are invited to a Zoom call. While I look forward to a time when face-to-face interactions are the norm again, I am grateful for the wide acceptance of this new tool that will continue to help us support patients and families everywhere.

We’ve learned that it’s not about the medium, it’s about the message, and the way it’s delivered.

Jessica Nutik Zitter (@JessicaZitter), a palliative medicine and critical care doctor in Northern California, is the author of “Extreme Measures: Finding a Better Path to the End of Life.”

A.A. to Zoom, Substance Abuse Treatment Goes Online

Until the coronavirus pandemic, their meetings took place quietly, every day, discreet gatherings in the basements of churches, a spare room at the YMCA, the back of a cafe. But members of Alcoholics Anonymous and other groups of recovering substance abusers found the doors quickly shut this spring, to prevent the spread of Covid-19.

What happened next is one of those creative cascades the virus has indirectly set off. Rehabilitation moved online, almost overnight, with zeal. Not only are thousands of A.A. meetings taking place on Zoom and other digital hangouts, but other major players in the rehabilitation industry have leapt in, transforming a daily ritual that many credit with saving their lives.

“A.A. members I speak to are well beyond the initial fascination with the idea that they are looking at a screen of Hollywood squares,” said Dr. Lynn Hankes, 84, who has been in recovery for 43 years and is a retired physician in Florida with three decades of experience treating addiction. “They thank Zoom for their very survival.”

Though online rehab rose as an emergency stopgap measure, people in the field say it is likely to become a permanent part of the way substance abuse is treated. Being able to find a meeting to log into 24/7 has welcome advantages for people who lack transportation, are ill, juggling parenting or work challenges that make an in-person meeting tough on a given day and may help keep them more seamlessly connected to a support network. Online meetings can also be a good steppingstone for people just starting rehab.

“There are so many positives — people don’t need to travel. It saves time,” said Dr. Andrew Saxon, an addiction expert and professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. “The potential for people who wouldn’t have access to treatment easily to get it is a big bonus.”

Participants of the combined virtual and in-person therapy group at Ottagan. While the convenience and ease of telehealth is undeniable, some say they crave the intensity of physical presence.
Participants of the combined virtual and in-person therapy group at Ottagan. While the convenience and ease of telehealth is undeniable, some say they crave the intensity of physical presence.Credit…Emily Rose Bennett for The New York Times

Todd Holland lives in northern Utah, and he marvels at the availability of virtual meetings of Narcotics Anonymous around the clock. He recently checked out one in Pakistan that he heard had a good speaker, but had trouble with some delay in the video and in understanding the speaker’s accent.

Some participants say the online experience can have a surprisingly intimate feel to it.

“You get more a feel for total strangers, like when a cat jumps on their lap or a kid might run around in the background,” said a 58-year-old A.A. member in early recovery in Portland, Ore., who declined to give his name, citing the organization’s recommendations not to seek personal publicity. Plus, he added, there are no physical logistics to attending online. “You don’t go into a stinky basement and walk past smokers and don’t have to drive.”

At the same time, he and others say they crave the raw intensity of physical presence.

“I really miss hugging people,” he said. “The first time I can go back to the church on the corner for a meeting, I will, but I’ll still do meetings online.”

Mr. Holland, who for decades abused drugs until Narcotics Anonymous helped him stay sober for eight years, said the online meetings can “lack the feeling of emotion and the way the spirits and principles get expressed.”

It is too early for data on the effectiveness of online rehabilitation compared to in-person sessions. There has been some recent research validating the use of the technology for related areas of treatment, like PTSD and depression that suggests hope for the approach, some experts in the field said.

Even those people who say in-person therapy will remain superior also said the development has proved a huge benefit for many who would otherwise have otherwise faced one of the biggest threats to recovery: isolation.

The implications extend well beyond the pandemic. That’s because the entire system of rehabilitation has been grappling for years with practices some see as both dogmatic and insufficiently effective given high rates of relapse.

A worksheet to help patients clarify their thoughts and behaviors during the Ottagan group session.Credit…Emily Rose Bennett for The New York Times

“It’s both challenging our preconceived concerns about what is necessary for treatment and recovery but also validating the need for connection with a peer group and the need for immediate access,” said Samantha Pauley, national director of virtual services for the Hazelden Betty Ford Foundation, an addiction treatment and advocacy organization, with clinics around the country.

In 2019, Hazelden Betty Ford first tried online group therapy with patients in San Diego attending intensive outpatient sessions (three-to-four hours a day, three -to-four hours a week). When the pandemic hit, the organization rolled out the concept in seven states, California, Washington, Minnesota, Florida, New York, Illinois and Oregon — where Ms. Pauley works — and has since expanded to New Jersey, Missouri, Colorado and Wisconsin.

Ms. Pauley said 4,300 people have participated in such intensive therapy — which entails logging into group or individual sessions using a platform called Mend that is like Zoom. Preliminary results, she said, show the treatment is as effective as in-person meetings at reducing cravings and other symptoms. An additional 2,500 people have participated in support groups for family members.

If not for Covid, Ms. Pauley said, the “creative exploration” of online meetings would still have happened but much more slowly.

One hurdle to intensive online rehab involves drug testing of patients, who would ordinarily give saliva or urine samples under in-person supervision. A handful of alternatives have emerged, including one in which people spit into a testing cup while being observed onscreen by a provider who verifies the person’s identity. The sample then gets dropped at a clinic or mailed in, though the risk of trickery always remains. In other cases, patients can visit a lab for a drug test.

Kim Villanueva, of Muskegon, Mich., shared a story during the group therapy session at Ottagan.Credit…Emily Rose Bennett for The New York Times

Additionally, some clinical signs of duress can’t be as easily diagnosed over a screen.

“You can’t see the perspiration that might indicate the person suffering mild withdrawal. There are limitations,” said Dr. Christopher Bundy, president of the Federation of State Physician Health Programs, a group representing 48 state physician health programs that serve doctors in recovery. He said that hundreds of physicians in these programs are attending regular virtual professionally monitoring meetings in which they meet with a handful of specialists for peer support and to assess their progress.

“This sort of thing has challenged our assumptions,” he said of the pandemic and the use of the internet for these therapies. “There’s a sense it’s not the same, but it’s close enough.”

Other participants in drug rehab and leaders in the field say that while online has been a good stopgap measure, they also hope that in-person meetings will return soon.

“It’s been a mixed blessing,” said David Teater, who wears two hats: he’s in recovery himself since the 1980s, and he’s executive director of Ottagan Addictions Recovery, a residential and outpatient treatment center serving low-income patients in western Michigan whose therapy typical gets paid through Medicaid.

In that capacity, he said online tools have been a godsend because, simply, they allowed service to continue. Through $25,000 in grants, the center got new computers and other technology that allowed it to do telemedicine, and set up a “Zoom room.” It includes a 55-inch monitor so that people who are Zooming in can see the counselor as well as the people who feel comfortable enough to come in-person and sit at a social distance wearing masks.

“We think it works equally well, we really do,” Mr. Teater said.

It’s Time for a Digital Detox. (You Know You Need It.)

When is enough enough?

Even though the presidential election is over, we’re still doomscrolling through gloomy news about the coronavirus surge. The rest of your daily routine is probably something like mine while stuck at home in the pandemic: Divided among streaming movies on Netflix, watching home improvement videos on YouTube and playing video games. All of these activities involve staring at a screen.

There has to be more to life than this. With the holiday season upon us, now is a good time to take a breather and consider a digital detox.

No, that doesn’t mean quitting the internet cold turkey. No one would expect that from us right now. Think of it as going on a diet and replacing bad habits with healthier ones to give our weary eyes some much needed downtime from tech.

“There’s lots of great things to do online, but moderation is often the best rule for life, and it’s no different when it comes to screens,” said Jean Twenge, a psychology professor at San Diego State University and the author of “iGen,” a book about younger generations growing up in the smartphone era.

Too much screen time can take a toll on our mental health, depriving us of sleep and more productive tasks, experts said. I, for one, am experiencing this. Before the pandemic, my average daily screen time on my phone was three and a half hours. Over the last eight months, that has nearly doubled.

So I turned to psychology experts for their advice. From setting limits to finding alternatives to being glued to our phones, here’s what we can do.

Come Up With a Plan

Not all screen time is bad — after all, many students are attending school via videoconferencing apps. So Step One is assessing which parts of screen time feel toxic and make you unhappy. That could be reading the news or scrolling through Twitter and Facebook. Step Two is creating a realistic plan to minimize consumption of the bad stuff.

You could set modest goals, such as a time limit of 20 minutes a day for reading news on weekends. If that feels doable, shorten the time limit and make it a daily goal. Repetition will help you form new habits.

That’s easier said than done. Adam Gazzaley, a neuroscientist and co-author of the book “The Distracted Mind: Ancient Brains in a High-Tech World,” recommended creating calendar events for just about everything, including browsing the web and taking breaks. This helps create structure.

For example, you could block off 8 a.m. to read the news for 10 minutes, and 20 minutes from 1 p.m. for riding the exercise bike. If you feel tempted to pick up your phone during your exercise break, you would be aware that any screen time would be violating the time you dedicated to exercise.

Most important, treat screen time as if it were a piece of candy that you occasionally allow yourself to indulge. Don’t think of it as taking a break as that may do the opposite of relaxing you.

“Not all breaks are created equal,” Dr. Gazzaley said. “If you take a break and go into social media or a news program, it can get hard to get out of that rabbit hole.”

Create No-Phone Zones

We need to recharge our phones overnight, but that doesn’t mean the devices need to be next to us while we sleep. Many studies have shown that people who keep phones in their bedrooms sleep more poorly, according to Dr. Twenge.

Smartphones are harmful to our slumber in many ways. The blue light from screens can trick our brains into thinking it’s daytime, and some content we consume — especially news — can be psychologically stimulating and keep us awake. So it’s best not to look at phones within an hour before bed. What’s more, the phone’s proximity could tempt you to wake up and check it in the middle of the night.

“My No. 1 piece of advice is no phones in the bedroom overnight — this is for adults and teens,” Dr. Twenge said. “Have a charging station outside the bedroom.”

Outside of our bedrooms, we can create other No-Phone Zones. The dinner table, for example, is a prime opportunity for families to agree to put phones away for at least 30 minutes and reconnect.

Resist the Hooks

Tech products have designed many mechanisms to keep us glued to our screens. Facebook and Twitter, for example, made their timelines so that you could scroll endlessly through updates, maximizing the amount of time you spend on their sites.

Adam Alter, a marketing professor at New York University’s Stern School of Business and author of the book “Irresistible: The Rise of Addictive Technology and the Business of Keeping Us Hooked,” said that tech companies employed techniques in behavioral psychology that make us addicted to their products.

He highlighted two major hooks:

  • Artificial goals. Similar to video games, social media sites create goals to keep users engaged. Those include the number of likes and followers we accrue on Facebook or Twitter. The problem? The goals are never fulfilled.

  • Friction-free media. YouTube automatically plays the next recommended video, not to mention the never-ending Facebook and Twitter scrolling. “Before there was a natural end to every experience,” like reading the last page of a book, he said. “One of the biggest things tech companies have done was to remove stopping cues.”

What to do? For starters, we can resist the hooks by making our phones less intrusive. Turn off notifications for all apps except those that are essential for work and keeping in touch with people you care about. If you feel strongly addicted, take an extreme measure and turn the phone to grayscale mode, Dr. Alter said.

There’s also a simpler exercise. We can remind ourselves that outside of work, a lot of what we do online doesn’t matter, and it’s time that can be better spent elsewhere.

“The difference between getting 10 likes and 20 likes, it’s all just meaningless,” Dr. Alter said.

Why I Decided to Stop Writing About My Children


Credit Giselle Potter

There is a hunger in our culture for true stories from the parenting trenches where life is lived mud-flecked and raw. I’ve written extensively, intimately, damningly, about my children for seven years without once thinking about it from the point of view of their feelings and their privacy. A few months ago I stopped.

I wish I could say that I deeply reflected on the ethics of writing about my children and heroically pivoted myself out of a concern for my character, but here’s what really happened: My father called.

He called me after reading a blog post I had written about my son’s first signs of puberty. It seems an obvious line-crossing that I wrote about such an intimate detail, but I did. At the time I didn’t pause for a split second; I was more than willing to go there. I had been writing and reading extensively about parenting tweens. I knew people might be mildly shocked, but mostly interested.

We live in a break-the-internet arms race of oversharing. And adolescent sexuality is an emergent, fascinating topic, especially for parents who are figuring out how to address difficult questions with their children. For example: I ate up Peggy Orenstein’s marvelous new book, “Girls & Sex,” with a spoon, shocked and upset the whole way through.

But when my dad said, “Elizabeth, are you pausing to deeply consider what you’re writing about?” I wanted to get defensive. I said, “Uh. I kinda perceive myself as a confessional poet, Dad,” I said, “Heir to Plath, Sexton and Sharon Olds. And the photographer Sally Mann, if I’m honest, Dad.”

But he said, “I’m not talking about art. I’m talking about my grandson.”

He was a lion for his grandson. I listened. I heard him. His words went to my heart, my maternal heart, which is in equal parts steel and cornmeal mush. I thanked him honestly for his feedback, got off the phone, and cried into my daughter’s stuffed animals, which are very soft and plush and forgiving.

So began my wrestling with my relationship with the Nora Ephron line, “Everything is copy.” Until now it has been my battle cry and artistic excuse for printing whatever I wanted whenever I wanted with very blinkered vision. Maybe, in fact, not everything is copy. Maybe it’s people’s lives, and we should be considerate and loving and respectful of their privacy. It’s a new point of view for me in our clickbait culture of confessionalism and parading nakedness.

When I started blogging, my kids were babes in arms, hardly people; they were creatures, mewling, milk-drunk, with eyes so deeply slate they were alien-denim blue.

I used the blog as a live journal to get me through postpartum depression and “the lost years” for me that were “the magic years” for them, when I felt overwhelmed by washing out sippy cups, lurking at the edges of the mommy wars, and co-sleeping and diapering.

Writing made the joys and the hardship of parenting into stories. Stories I could tell. Stories that I considered as one considers a diorama.

I was always the narrator, the main character, even if I was also the storm-tossed heroine, the hot mess in mom jeans who couldn’t get the overalls on her 2-year-old. Or figure out fourth-grade fractions homework. I was working out my issues. My kids were always satellites to the big round-faced moon of me.

I’ve shamed their eating habits in chat rooms. I have Facebooked the things they’ve said. I have skewered them horribly, but also with great interest and affection, as a collector might do to some butterflies.

I think Sally Mann’s photographs of her kids are luminous and transcendent, while others accuse her of child pornography. The lines between art and privacy are blurry. You have to consider what you are doing carefully. And previously I wasn’t.

Sally Mann and I don’t belong in the same sentence. I’ve been a Baltimore mommy-blogger writing about things like head lice. She is a world-class artist. But she and I have done the same thing: publicly disrobed our children.

My children didn’t give me their permission to tell their stories, or strike poses in a waterfall, naked, gorgeous as all get out, and human, with lives ahead of them, as Sally Mann posed hers. And now that I see that, I don’t want to mar my children’s glory and subvert their beginnings for my so-called art.

If I’m going to continue writing, I realize I need to find some new material, and for that I’m going to have to look more deeply within myself or entirely outside. For inspiration I have turned to writing about nature. The environment. The sea. Things that are bigger than me. I’ve been reading John Muir. I’ve been reading “Braiding Sweetgrass.” Nature is for all to see. Nurture is between me and my kids, off the record.

Elizabeth Bastos lives in Baltimore and writes about urban nature. Follow her at thenaturehood.blogspot.com and on Twitter @elizabethbastos.

Living with a Teenage Data Hog


Credit iStock

After children reach a certain age, most parents give in to their desire for a mobile phone. We like being able to find them at any moment, and they risk being left out if their friends can’t ping them. A Pew Research Center report from last year found that 88 percent of American teenagers now have phones.

But today’s smartphones have earned that name because of their ability to suck in and spit out data at ever-faster rates. That gets expensive, quickly, and figuring out who should pay for the data, how much, and according to what rules, can be a giant headache.

So first, an opening proposition: The ability to access the internet via a cellular signal, in those passing moments when Wi-Fi is not available, is a want and not a need for most teenagers. And if they want it, they should pay for it themselves.

But when I share that assertion with many parents I know, they often respond by patting me on the head and telling me to get back to them when my 10-year-old has a phone and all her friends do, too. To those parents, a data plan is no indulgence. Their kids are busy — constantly on the way to an athletic event or rehearsal. They don’t want to deprive their kids of the ability to stream music or stay connected with their friends on data-draining apps like Snapchat. So a data plan is a given, and the parents are willing to pay.

But just how high a bill is reasonable? I suggest the budgeting approach: Parents pay for a certain amount of data each month, the children track how much they’ve used, and then they pay for anything beyond that allotted amount.

It’s simple enough in theory. Carriers lets customers check to see how much data each person in a family plan has used so far during the month, and the privilege of having a phone should come with the responsibility of keeping track.

That approach does, however, require you to sit down with your teenager and identify the sources of data drain and perhaps set rules for when those apps ought to go off. The Times’s Wired Well columnist, Jennifer Jolly, lives with a data-draining teenager. She suggests turning off any features on a teen’s phone that drain data automatically in the background. Also, track the apps that use the most data and limit data hogs like Spotify or Snapchat to times when the teenager has Wi-Fi access. One additional hint: The more video an app records, transmits and receives, the higher the data bill is likely to be. Call your carrier or consult online forums if you need more help.

In an ideal world, this approach teaches patience, self-control and restraint. Your kids can always watch a video a little later over Wi-Fi, after all. And many messages – most, even – can wait a bit.

But in a less than ideal world, teenagers tend to go over their caps, especially if their friends send lots of videos back and forth via Snapchat. Some parents have enough money to simply pay for the overages. But discussions about those bills are useful. If we don’t set limits, after all, who will? And isn’t our job to get our kids ready for the moment when they really will be paying their own bills?

A few years ago, I wrote about the Russell Plan, named after Mary Kay Russell, a mother of four sons in Naperville, Ill. She added her sons to the family’s cellphone plan when they were ready for their first phones, and the cheap devices they received came with unlimited calls and texting. The boys were welcome to burn data to their hearts’ content on an upgraded phone, but if they wanted to do that, they would have to pay for the device and prepay $360 for a year’s worth of data. The oldest waited until age 21 to get his first fancy phone.

Perhaps his response to the family’s strategy was not such a big surprise. The cost of a smartphone plus data is a big pile of cash to a middle school student who may not have many ways to earn money. Parents who can afford it might consider raising a child’s allowance some to put the decision just within their reach – and make the possibility of waiting on an upgraded phone more enticing.

How much more allowance might they get? It depends on whether you’re asking them to use allowance to cover lunch, snacks, transportation and clothing, too. But you could increase the allowance enough to pay for 50 or 75 percent of a basic data plan, so that the choice to purchase it would involve some sacrifices elsewhere.

Yes, you’re technically “paying” for the data plan in this instance, but that’s true with allowance in general. Once your children have it, the money will feel like it’s their own, and the trade-off will feel real, too.

The Russell children could have asked for upgraded mobile devices and money toward data for birthdays or Christmas, but they often had other priorities. Which is great: We want our children making financial trade-offs, since that is what they’ll have to do as grownups just about every day of their adult lives.

Ron Lieber is the Your Money columnist for The New York Times and the author of “The Opposite of Spoiled,” about parenting, money and values.


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Computer Vision Syndrome Affects Millions


Credit Paul Rogers

Joanne Reitano is a professor of history at LaGuardia Community College in Long Island City, Queens. She writes wonderful books about the history of the city and state, and has recently been spending many hours — sometimes all day — at her computer to revise her first book, “The Restless City.” But while sitting in front of the screen, she told me, “I developed burning in my eyes that made it very difficult to work.”

After resting her eyes for a while, the discomfort abates, but it quickly returns when she goes back to the computer. “If I was playing computer games, I’d turn off the computer, but I need it to work,” the frustrated professor said.

Dr. Reitano has a condition called computer vision syndrome. She is hardly alone. It can affect anyone who spends three or more hours a day in front of computer monitors, and the population at risk is potentially huge.

Worldwide, up to 70 million workers are at risk for computer vision syndrome, and those numbers are only likely to grow. In a report about the condition written by eye care specialists in Nigeria and Botswana and published in Medical Practice and Reviews, the authors detail an expanding list of professionals at risk — accountants, architects, bankers, engineers, flight controllers, graphic artists, journalists, academicians, secretaries and students — all of whom “cannot work without the help of computer.”

And that’s not counting the millions of children and adolescents who spend many hours a day playing computer games.

Studies have indicated 70 percent to 90 percent of people who use computers extensively, whether for work or play, have one or more symptoms of computer vision syndrome. The effects of prolonged computer use are not just vision-related. Complaints include neurological symptoms like chronic headaches and musculoskeletal problems like neck and back pain.

The report’s authors, Tope Raymond Akinbinu of Nigeria and Y. J. Mashalla of Botswana, cited four studies demonstrating that use of a computer for even three hours a day is likely to result in eye symptoms, low back pain, tension headache and psychosocial stress.

Still, the most common computer-related complaint involves the eyes, which can develop blurred or double vision as well as burning, itching, dryness and redness, all of which can interfere with work performance.

One reason the problem is so pervasive: Unlike words printed on a page that have sharply defined edges, electronic characters, which are made up of pixels, have blurred edges, making it more difficult for eyes to maintain focus. Unconsciously, the eyes repeatedly attempt to rest by shifting their focus to an area behind the screen, and this constant switch between screen and relaxation point creates eyestrain and fatigue.

Another unconscious effect is a greatly reduced frequency of blinking, which can result in dry, irritated eyes. Instead of a normal blink rate of 17 or more blinks a minute, while working on a computer the blink rate is often reduced to only about 12 to 15 blinks.

But there are additional problems. The head’s distance from the screen and position in relation to it are also important risk factors. To give the eyes a comfortable focusing distance, the screen should be about 20 to 26 inches away from the face. The closer the eyes are to the monitor, the harder they have to work to accommodate to it.

In addition, when looking straight ahead, the eyes should be at the level of the top of the monitor. The University of Pennsylvania’s ophthalmology department advises that the center of the monitor should be about four to eight inches lower than the eyes to minimize dryness and itching by lessening the exposed surface of the eyes because they are not opened wide. This distance also allows the neck to remain in a more relaxed position.

Yet, in a study in Iran of 642 pre-university students reported in Biotechnology and Health Sciences last year, 71 percent sat too close to the monitor for comfort, and two-thirds were improperly positioned directly opposite or below the monitor.

Improper lighting and glare are another problem. Contrast is critical, best achieved with black writing on a white screen. The screen should be brighter than the ambient light — overly bright overhead light and streaming daylight force the eyes to strain to see what is on the screen. A bright monitor also causes your pupils to constrict, giving the eyes a greater range of focus.

You might need to reposition the desk, use a dimmer switch on overhead lights, or lower window shades to keep out sunlight. In addition, using a flat screen with an antiglare cover, and wearing glare-reducing or tinted lenses can help to minimize glare.

Be sure to use a font size best suited to your visual acuity, and have your eyes examined regularly — at least once a year — to be sure your prescription is up-to-date. This is especially important for people older than 40 and for children who are heavy users of computers because visual acuity can change with age. Make sure, too, that your monitor has a high-resolution display that provides sharper type and crisper images. And clean the monitor often with an antistatic dust cloth.

Those who work from printed materials, moving back and forth from them to the screen, could minimize neck strain by mounting documents on a stand next to the monitor. If, like me, you use many different printed documents at the same time, consider getting special computer glasses — bifocal or progressive lenses with the upper portion ideal for screen reading and the lower designed for print distance.

While prevention is most important, if you already have symptoms of computer vision syndrome, there are ways to reduce or eliminate them. Ophthalmologists suggest adhering to the “20-20-20” rule: Every 20 minutes, take a 20-second break and look at something 20 feet away.

Consciously blink as often as possible to keep eye surfaces well lubricated. To further counter dryness, redness and painful irritation, use lubricating eye drops several times a day. My ophthalmologist recommends products free of preservatives sold in single-use dispensers.

You can also reduce the risk of dry eyes by keeping air from blowing in your face and by using a humidifier to add moisture to the air in the room. And Dr. Reitano said her eye doctor also suggested applying warm moist compresses to her eyes every morning.


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Giving New Doctors the Tools They Need


Credit Early Wilson

They say if all you have is a hammer, everything looks like a nail. I wonder, then, why my toolbox often seems so inadequate for fixing my patients.

I open one recent afternoon in clinic with a middle-aged man I’ve come to know well. He’s drunk. His breath smells of alcohol and he slurs his words. He tells me his brother’s in jail, his mother died, and he punched a neighbor who tried to steal his wallet. In the past year, he’s been admitted to the hospital countless times for everything from falling to getting injured in a fight to failing to take his medications.

“High risk for readmission,” an automated email plops into my inbox each time he’s admitted. Thanks, I’m on it.

I search for mental health and substance use resources we haven’t yet exhausted. I speak briefly with a psychiatrist and case manager and a social worker who is arranging transportation back to the housing he’s in danger of being thrown out of.

“Maybe we increase his mood-stabilizer?” I offer, mostly just to say something. When all you have is a hammer…

The afternoon doesn’t get easier. I see a patient whose heart failure had been in good control with a telemedicine service that had checked his weight at home and adjusted his medications accordingly. But the service has been cancelled, and now he’s in our clinic, gasping for air as fluid fills his lungs.

He’s followed by an older man who’s been on opioid painkillers for a decade — and who I now suspect is selling extra pills on the street. I’m running 45 minutes late by the time I greet an understandably frustrated woman who, a computer alert informs me, is overdue for her first colonoscopy. She balks when I bring it up, and I don’t have the words or the time to convince her otherwise.

The afternoon was not unusual. At the end of most days, I find myself searching for nails that I can hammer.

Part of the problem is the tool kit we assemble during medical training. We’re educated largely in a biomedical framework. We diagnose disease with textbook knowledge and prescribe medications because those are the hammers we have.

But consider the skills I would need to be more effective in just this one clinic session: understanding social issues that contribute to health; marshaling support resources like case management, social work and rehabilitation centers; exploring my patients’ values and goals and encouraging behavior change; leading interdisciplinary care teams; employing new technologies and methods of patient engagement like telemedicine; and appreciating how health systems fit together to influence an individual patient’s care — from home care and community centers to clinics and hospitals. None have traditionally been emphasized in medical education — and, unsurprisingly, doctors in training like myself are often ill-equipped to practice in today’s health care environment.

Medicine has long been a discipline predicated on memorization, which made sense in a world of textbooks, microscopes and information monopoly. But rooting medical training primarily in knowledge acquisition is increasingly insufficient and inefficient. In an era of big data, Google and iPhones, doctors don’t so much need to know as they need to access, synthesize and apply. We’re increasingly asked to consider not just patients, but communities. We’re expected to practice not as individuals, but as team members. And now — liberated from carrying every diagnostic and treatment detail around in our heads — we have both the responsibility and the luxury of deciding what a doctor should be in the 21st century.

Some medical educators are trying to figure it out, with a greater emphasis on new technologies, collaborative care, wellness and community health.

The new Dell Medical School at the University of Texas, Austin, which enrolls its first class in June, is hoping to revolutionize medical education. The school plans to focus on helping students understand how health systems, communities and social issues contribute to individual health through a variety of innovative methods.

Instead of traditional lecture halls, Dell’s students will learn in collaborative workspaces with a curriculum that emphasizes team-based management of patients. They’ll take weekly classes with pharmacy, nursing, social work and engineering students. Dell’s “Innovation, Leadership and Discovery” program affords students an entire year to pursue projects related to population health and delivery system redesign.

Dell also features a unique collaboration with the university’s College of Fine Arts — known as the Design Institute for Health — to bring design thinking to health care. Here students will learn to think about everything from better hospital gowns and more hospitable hospital rooms to how patients access services online and how to make waiting rooms obsolete.

“It’s an incredible gift to start from scratch,” said Dr. Clay Johnston, the school’s first dean. “We can start by looking at where the biggest gaps and problems are. Then say, O.K., given those needs, what should doctors and the medical system look like in the future?”

The health system Kaiser Permanente recently announced its own plans to open a medical school in 2019, in Pasadena, Calif. The medical school, like the health system, will emphasize integrated care, the latest medical evidence and new technologies like online doctor visits.

“We recognize the importance of providing care in alternate settings,” says Dr. Edward Ellison, who is helping to oversee the creation of the school. “We’ll take care of you when you’re sick. But we’ll also help you stay healthy when you’re home.”

While most medical schools are trying to get students out of lecture halls and into hospitals, Kaiser Permanente hopes to get students out of hospitals and into communities. Students will visit patients in their homes to see how they live and what behavior change looks like in living rooms instead of hospital rooms. They’ll also be trained as emergency medical technicians — riding in ambulances alongside other medical professionals, responding to accidents, violence and trauma in their communities.

The American Medical Association, for its part, has provided over $11 million to established medical schools to reimagine their curricula and better prepare students for a rapidly evolving health care environment.

Older physicians, medical educators, policy makers and patients will continue to debate what doctors should be taught and what they should know. But the deeper question is how doctors can learn to think — to solve problems that can’t be solved with the tools we currently have. Because ultimately, there’s no better hammer than that.

Dhruv Khullar, M.D., M.P.P. is a resident physician at Massachusetts General Hospital and Harvard Medical School. Follow him on Twitter: @DhruvKhullar.

Aging in Place


Credit Paul Rogers

When I asked the other three members of my walking group, all of whom are in their mid to upper 70s, whether they had any concerns about future living arrangements, they each said they had none despite the fact that, like me, they live in multistory private homes without elevators and, in two cases, without bathrooms on every floor.

My Los Angeles son asked recently what I might do if I could no longer live in my house, and I flippantly replied, “I’m coming to live with you.” The advantages: I’d be surrounded by a loving and supportive family, and the warm weather is a benefit for someone like me who becomes increasingly intolerant of the cold with each passing year. The disadvantages: I’d lose a familiar community and a host of friends, and his house, unlike mine, is on a steep hill with no nearby stores; if I could no longer drive, I’d have to be chauffeured everywhere.

Probably my biggest deterrent would be relinquishing my independence and the incredible number of “treasures” I’ve amassed over the last half century. The junk would be easy, but parting with the works of art and mementos would be like cutting out my heart.

I suspect that most people are reluctant to think about changing where and how they live as long as they are managing well at the moment. Lisa Selin Davis reports in AARP magazine that “almost 90 percent of Americans 65 or older plan to stay in their homes as they age.” Yet for many, the design of their homes and communities does not suit older adults who lack the mobility, agility and swiftness of the young.

For those who wish to age in place, the authors of “70Candles: Women Thriving in Their 8th Decade,” Jane Giddan and Ellen Cole, list such often-needed home attributes as an absence of stairs, wide doorways to accommodate a walker or wheelchair, slip-resistant floors, lever-style door knobs, remotely controlled lighting, walk-in showers, railings, ramps and lifts. Add to these a 24-hour help system, mobile phone, surveillance cameras and GPS locaters that enable family members to monitor the well-being of their elders.

In many communities, volunteer organizations, like Good Neighbors of Park Slope in Brooklyn and Staying in Place in Woodstock, N.Y., help older residents remain in their homes and live easier and more fulfilling lives.

While many young adults chose to live and bring up children in the suburbs, a growing number of empty-nested retirees are now moving to city centers where they can access public transportation, shop on foot for food and household needs, and enjoy cultural offerings and friendly gatherings without depending unduly on others.

One reason my friends and I are unwilling to even consider leaving our Brooklyn community is our ability to walk to supermarkets, banks, food co-ops, hardware stores, worship and recreational facilities, and get virtually everywhere in the city with low-cost and usually highly efficient public transportation. No driving necessary.

We also wallow in the joys of near-daily walks in a big, beautiful urban park, remarking each time about some lovely vista — the moon, sunrise, visible planets, new plantings and resident wildlife.

Throughout the country, communities are being retrofitted to accommodate the tsunami of elders expected to live there as baby boomers age. Changes like altering traffic signals and street crossings to give pedestrians more time to cross enhance safety for people whose mobility is compromised. New York City, for example, has created Aging Improvement Districts, so far in East Harlem, the Upper West Side and Bedford-Stuyvesant, to help older people “live as independently and engaged in the city as possible,” Ms. Giddan and Ms. Cole wrote. In East Harlem, for example, merchants have made signs easier to read and provided folding chairs for seniors who wish to rest before and after shopping.

In Philadelphia, a nonprofit organization, Friends in the City, calls itself a “community without walls” designed to bring members closer to the city’s resources and to one another. It offers seniors a daily variety of programs to suit many cultural and recreational interests.

Also evolving is the concept of home sharing, in which several older people who did not necessarily know one another get together to buy a home in which to live and share responsibilities for shopping, cooking, cleaning and home repair. For example, in Oregon, Let’s Share Housing, and in Vermont, Home Share Now, have online services that connect people with similar needs, Ms. Giddan and Ms. Cole report. There’s also an online matching service — Roommates4Boomers.com — for women 50 and over looking for compatible living mates.

Of course, there are still many older adults, widows and widowers in particular, who for financial or personal reasons move in with a grown child’s family, sometimes in an attached apartment or separate floor. Host families may gain a built-in babysitter, and children can develop a more intimate relationship with grandma or grandpa.

For those with adequate finances, there is no shortage of for-profit retirement communities that help older people remain independent by providing supportive services and a host of amenities and activities. Some have extensive recreational and exercise facilities, as well as book and craft clubs, discussion groups and volunteer opportunities. Some take residents to theatrical productions and museums and on trips to nearby attractions.

I confess that retirement communities that house only older adults are not my style. I can’t imagine living in a place where I don’t see and interact with children on a daily basis. I find that nothing cheers me more than a smile or comment from a toddler. I guess I take after my father, who used to flirt with every child he noticed in a car near his. But I realize that, just as some people are averse to dogs, not everyone enjoys the companionship of a high-energy child.

For older people likely to require help with the activities of daily living, there are many assisted living facilities where residents can get more or less help, including aid with medications, feeding and ambulation, according to their changing needs.

And should I ever have to leave my home, Ms. Giddan and Ms. Cole point out that there is a new and growing cadre of professional organizers and moving managers to “help people sort through accumulated belongings, distribute and disperse what won’t be needed in the new setting, and assist with all stages of packing, moving and then unpacking, and staging the new home.”

This is the second of two columns about adjustments to aging. Read the first part: “Thriving at Age 70 and Beyond.”


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Favorite Moment of a First-Year Doctor


Dr. Dhruv Khullar

Dr. Dhruv KhullarCredit Tom Fitzsimmons

My favorite moment in residency was hearing about my friend’s favorite moment in residency.

Excited to have finished our first year as doctors — the most unsettling and demanding in medical training — we swapped stories of our most memorable experiences. He told me about his final evening in the intensive care unit, the end of a grueling month. He had made plans to unwind with a friend from out of town whom he hadn’t seen in years. Before leaving, he checked in on a patient he’d admitted the previous week, an elderly woman with dementia and a bad pneumonia that was getting worse. Her oxygen levels had now dipped so low he feared her heart would stop beating.

He’d grown close to the patient’s daughter, who had been at her mother’s bedside each day. The daughter had been struggling with whether her mother should be intubated if her condition deteriorated, which seemed likely. My friend told her he was transitioning off service and would be leaving for the night, but assured her that the next team would take good care of her mother.

She hesitated. Her brothers and sisters were flying in from around the country that night, she told him. They planned to discuss their mother’s life, her condition, her wishes moving forward. And she wanted him — the junior member of the team — to lead the family discussion.

He called his friend. He wouldn’t be making dinner. Then, he had his most meaningful conversation as a doctor.

As he gathered with the family, they told stories of who their mother was, what had been most important to her, and how she would want to die. Ultimately, they decided against intubation and focused on keeping her comfortable in her final days.

What struck me about my friend’s story is not only that he acted as an exemplary physician and helped his patient die a dignified death. It’s that it was important that he was the one having that conversation.

Too often in medicine, you feel like part of a machine, a cog in a massive bureaucracy. We cover each other’s shifts, we maintain a hospital’s patient flow — and at the end of many days, you feel nothing would have been different if another doctor subbed in.

This isn’t necessarily a bad thing. I don’t want a patient to fare differently simply because I’m on call rather than my friend. Much of medical training is an exercise in reducing this kind of variability from one doctor to the next. We start medical school with creative and distinct ways of thinking, but we soon learn to recognize patterns and approach problems in a standardized way: when you see X, think Y, and do Z.

Risk calculators, diagnostic algorithms and treatment guidelines support us in this role. Surgical checklists can prevent infections; timely stents can save lives; computers can reduce medication errors. But not always. Sometimes checklists don’t help, stents hurt, and computers lead to overdoses.

But standardized care, by definition, is not personalized care: it fails to acknowledge patients’ individuality. A calculator can predict your risk for disease, and a clinical trial can reveal the possible side effects of treatment. Neither, though, can tell individual doctors or patients what to do — what tradeoffs to make, what quality of life to accept.

Standardization can also strip doctors of a sense of ownership and autonomy. In a health environment bustling with protocols and metrics, we sometimes feel less like doctors caring for people than technicians generating outcomes. With a growing reverence for algorithms comes a perception that physicians are somehow replaceable, or at least interchangeable. But individual doctor’s judgments, patients’ preferences, and connections between clinicians and patients are what make health care meaningful.

New technologies will likely further complicate the issue. Standardized care may soon give way to computerized care. Already, hospitals are teaming up with IBM’s Watson — the computer that won “Jeopardy!” — to digest new medical knowledge, collect data, diagnose disease, adjust medications and check for errors. A recent report by McKinsey & Company found that almost half of all activities American workers perform could be automated by currently available technologies. Contrary to prevailing thought, it’s not just low-skilled occupations at risk: physicians, financial managers, senior executives and the like will have significant amounts of their work automated.

Will doctors, then, soon be replaceable?

A better question is how best to incorporate new technologies into the day-to-day work that doctors do. The best medicine is an essential art, and algorithms, if thoughtfully deployed, can free us to make more of it. The great contribution of technology, then, may not be improved efficiency and safety. It may be crystallizing what only doctors — as humans — can offer: critical thinking, clinical intuition, empathic care, exploring what’s important to patients so they can make the decisions that are right for them.

We haven’t yet found the right balance between standardized care and personalized care — between automation and autonomy, algorithms and art. We know that protocols can improve care, but also that they can diminish individuality. We shouldn’t think of them as replacing what we do, but rather, as making room for what only we can do.

Dhruv Khullar, M.D., M.P.P. is a resident physician at Massachusetts General Hospital and Harvard Medical School. Follow him on Twitter: @DhruvKhullar.