2021年8月4日 星期三

Parenting Through Terminal Illness

As their father fights to live, my children and I learn how to grieve.

Parenting Through Terminal Illness

By Kelsie Snow

Mikyung Lee

One night last fall, as I sat in bed with my 9-year-old son, Cohen, he looked up at me through tears and asked, "Do you think Daddy will have a long life or a short life?"

It was a big question from a little boy, but not an unexpected one.

Two years ago, my husband, Chris, was diagnosed with the progressive neurodegenerative disease amyotrophic lateral sclerosis, or A.L.S. Doctors said he had six to 12 months to live. He was 37 at the time.

Thanks to a promising clinical trial Chris is still very much alive, but the experimental medicine injected into his spine every four weeks has not worked perfectly. He first lost the use of his dominant hand, and then, after nine months of no disease progression, his face started to change. What began as a slightly lopsided smile snowballed into almost total atrophy of his facial muscles. His lips weakened, so he could no longer purse them together to make consonant sounds or to kiss us. Then his swallowing muscles deteriorated, and he began choking on his food.

It was terrifying for all of us. For Cohen, the panic was palpable. His heart would race. He would sob and sweat and look at me desperately for reassurance that his dad was not going to choke and die. Our 6-year-old daughter, Willa, would reassure her brother, and herself, with a mantra we created for these episodes: "It's OK, Cohen. Remember, coughing is not choking."

After Chris was diagnosed, people often told me, "The kids will be all right," and while I understood the sentiment, I found it an immense oversimplification. The path to "all right" would undoubtedly be long, winding and, ultimately, up to me and Chris. We started reading about kids and grief; found therapists that were a good fit for both Cohen and Willa; and sought the advice of experts who work with families facing terminal illness.

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Andrea Warnick, a Toronto-based psychotherapist who holds a master's degree in thanatology, which is the study of dying, death and bereavement, has spent more than 20 years supporting grieving families and kids. She told me that while helping a grieving child can feel overwhelming, the most important elements are simple: Caregivers should work to form a secure attachment with the child and to facilitate open, honest communication.

"I consistently see so many families where really hard stuff happens, and those kids are still able to thrive in the world," Ms. Warnick said. "Those kids have adults in their life who are emotionally available to them."

A secure attachment, Ms. Warnick said, means that a child feels safe coming to a parent with anything that is on their mind, and that the parent accepts those questions and feelings without judgment.

"I talked to a parent last week and the question was, 'When my brother dies, can I get his Nintendo gaming system?'" Ms. Warnick said. "The parent was horrified, but I'm like, 'Don't shut it down! It doesn't mean he's not grieving his brother. It doesn't mean he's not upset that his brother's got cancer. It's just a very practical question.'"

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She said that parents who have an ill partner should strive to be as honest as possible with their grieving kids, even when honesty is hard. But establishing free-flowing communication doesn't mean you'll magically have all the answers. According to Diane Vines, a marriage and family therapist and clinical consultant for the Houston-based ChildTrauma Academy, how we react to a child's emotions can sometimes be more important than what we say.

During those moments when Chris stood up from the dinner table gasping for air and our son panicked, the key, Ms. Vines said, was that I did not.

"When you're watching somebody you love possibly choke to death, that's upsetting," she said. "We look around to see, should we panic right now? What should we be doing right now? What is everyone else doing?"

When parents manage those feelings with relative calm, children will often feel reassured and react more calmly, too, she said.

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One day during those traumatic weeks before Chris got a feeding tube inserted to help with the choking, I was driving Cohen to hockey practice when out of the blue he said, "My life is harder than a lot of other kids my age." I told him he wasn't wrong, that I was sorry and that I love him. I asked what was on his mind. He shrugged. He didn't seem sad or angry or worried or scared. He was simply stating a fact.

Most parents who contact Ms. Warnick are looking for the right language to use with their children, she said. "The harder job is actually being able to bear witness to our children's suffering," she added. "I think one of the most wonderful things we can do for kids is teach them about grief, and teach them that they have the capacity to survive their feelings, even the most intense ones."

Some months after Chris's feeding tube had alleviated our kids' panic, I tucked Willa into bed. That night she giggled and hugged me as hard as she could. "You know what, Mommy?" she said. "Sometimes I forget that Daddy has this sickness."

I kissed her cheeks and told her I was so happy she has those moments of forgetfulness. Letting kids know that it's OK to forget about their sadness and feel happy, Ms. Warnick said, is important.

"It doesn't mean that you're happy because your dad has A.L.S.; it means it's absolutely OK to enjoy life and be happy, even though your dad has A.L.S.," she said.

She reminded me that grief isn't a problem that needs fixing.

"I'm always trying to help kids understand that grief is not pathology," Ms. Warnick said. "There's nothing broken. It's a natural response to a hard situation, and it's rooted in your love for your person."

Their father's terminal illness is a part of my kids' reality — I can't change that. Instead, I will try my hardest to bear witness to their suffering. It won't be perfect. I won't always get it right, but we'll do it together.

Read More About Family and Grief

  • The pandemic has brought illness and death front and center for many families. Dr. Perri Klass and science writer Melinda Wenner Moyer each explored how to approach grieving with children.
  • Marisha Pessl and Sophie Blackall wrote about books that can help explain death to children and start conversations about grief.
  • Films about the fragility of life can similarly help parents explain loss to kids; Stacy Brick suggested 7 movies to help children dealing with grief.
  • Jessica Grose wondered in a previous NYT Parenting newsletter why small children often want to talk about death.
  • Christina Caron tapped experts for suggestions on how to begin healing in a season of grief.

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Tiny Victories

Parenting can be a grind. Let's celebrate the tiny victories.

My 4-year-old is obsessed with the Olympics right now. To encourage her to clean up her messes, my husband and I turn her chore into an Olympic event. We pretend to be the announcers and if she completes the task and breaks the world record, it's a gold medal! — Amy Gabbert, Minneapolis

If you want a chance to get your Tiny Victory published, find us on Instagram @NYTparenting and use the hashtag #tinyvictories; email us; or enter your Tiny Victory at the bottom of this page. Include your full name and location. Tiny Victories may be edited for clarity and style. Your name, location and comments may be published, but your contact information will not. By submitting to us, you agree that you have read, understand and accept the Reader Submission Terms in relation to all of the content and other information you send to us.

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2021年8月3日 星期二

Lock Florida down now!

Time to revisit the 2020 playbook.
A health care worker at a Covid-19 mobile testing site operated by the Florida Department of Health in Manatee County.Octavio Jones/Reuters
Author Headshot

By Paul Krugman

Opinion Columnist

When you're a wonk trying to be a pundit — or for that matter any kind of technocrat who wants to have real-world influence — it's usually not helpful to push for policies that you believe would be right in principle but have no political chance of becoming reality.

The prime example for me has been health insurance. If our goal is to make sure that everyone has adequate, affordable health care, why not just pay for everyone's care? On policy grounds, I've never disagreed with the proposition that we should have Medicare for all; there's even a pretty good case for direct provision of medical care along the lines of Britain's National Health Service. Why bother with a Rube Goldberg device like Obamacare, which uses regulations and subsidies to nudge private insurers into covering most people?

But the politics are impossible, and not just because of special interests: You'd have to persuade the 170 million Americans with private insurance to accept something completely different. Even though most of them would probably be better off, that's too heavy a lift. So incremental reform, possibly evolving over time into single-payer, is how it's going to have to be.

Sometimes, though, it may be helpful to talk about what a government really should be doing, even if there isn't a snowball's chance in Miami Beach that they'll take your advice, simply as a way of highlighting the wrongheadedness of what that government is actually doing.

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Which brings me to current pandemic policy in red states, the subject of today's column. Imagine for a moment that Gov. Ron DeSantis of Florida were to have a sudden attack of conscience — if he were suddenly to admit to himself the carnage his Covid denial has created — and were to do an abrupt about-face, trying to limit the damage. (Like I said, a snowball's chance in Miami Beach.) What would he do?

The answer, I'd submit, is that he'd call for an immediate, fairly strict lockdown: mask requirements, a ban on indoor dining, the works.

To see why, let's revisit the logic behind the lockdowns we had in 2020.

In the early days of the pandemic, effective vaccines seemed like a remote prospect, and it looked like a good bet that almost everyone would eventually come down with Covid-19. Even so, it was important that we "flatten the curve" in an attempt to avoid having too many people need hospitalization all at once so as not to overwhelm the health care system. And lockdowns did that.

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As it turned out, however, we had a scientific miracle: Remarkably effective vaccines became available faster than anyone had imagined possible. But this miracle didn't mean that the lockdowns had been a mistake. On the contrary, it meant that they were an even better idea than we realized, because they bought time to get vaccines developed and distributed. People who managed to avoid getting infected during the pandemic's first year, then got their shots, are now likely to dodge the virus altogether or suffer only a mild case. Infections deferred were infections avoided, after all.

Unfortunately, the U.S. vaccination drive, while very successful at first, eventually ran into a wall. Politics wasn't the only reason vaccination slowed to a crawl, but it was a large part of the story — and the resurgence of Covid associated with the Delta variant has been strongly concentrated in a few red states, of which Florida is the most important.

What I haven't seen too many people pointing out clearly is that thanks to this gratuitous policy failure, Florida and a few other states are basically back where the whole country was in 2020.

On one side, soaring case loads are overwhelming the hospitals. On the other side, there's good reason to believe that salvation awaits for those who manage to avoid getting infected in the next couple of months. At this point it's not a matter of developing and distributing vaccines; they're available. Now it's about getting people to take them. But there are growing signs that this is going to happen — that the great vaccination pause will soon be over and vaccination rates will surge again.

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Partly this is happening via individual choice: Despite Tucker Carlson's best efforts, the realization that not getting vaccinated is a huge mistake seems to be seeping through. Vaccination rates are rising again, especially in states with large numbers of new cases.

Employers are also taking a hand, with a growing number of private companies and some government agencies starting to require that their employees get vaccinated. These localized mandates won't cover everyone, but they'll probably help establish being vaccinated as the new norm.

So once again we're in a situation where making it through the next couple of months may well mean avoiding ever catching this thing.

The implications for my imaginary, conscience-stricken DeSantis are clear: He should call for a brief but intense lockdown that drastically reduces the number of new cases, sparing the hospital system from overload and buying time for vaccine resistance to crumble and his state to achieve something like herd immunity.

Needless to say, actual DeSantis will do the opposite, refusing to acknowledge the danger and doing all he can to prevent an effective response to the Delta surge. But I hope that my thought experiment at least has the virtue of showing how bad his likely behavior will be.

When do we get bumper stickers saying, "DeSantis denied, people died"?

Quick Hits

Remember when we were doing better than Europe?

These days, density is (slightly) your friend when it comes to vaccination.

Anti-drunk-driving in the infrastructure bill.

Andy Slavitt on how things have changed in the past month.

Feedback If you're enjoying what you're reading, please consider recommending it to friends. They can sign up here. If you want to share your thoughts on an item in this week's newsletter or on the newsletter in general, please email me at krugman-newsletter@nytimes.com.

Facing the Music

Covid wouldn't let you fly, but it did let you sing.YouTube

Mother, should I trust the government?

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