Tom Keane

It’s time for Boston to start talking about closing its exam schools

Improving the admissions process won’t change the systemic disparities created by selective schools.

People are up in arms about Boston’s exam schools. Traditionalists argue the three—Boston Latin School, Boston Latin Academy, and the John D. O’Bryant School of Mathematics and Science—should keep the same rigid admissions requirements they’ve had for decades: a mix of a test scores and students’ GPAs. Reformers want new measures for admittance, measures they hope will diversify the schools’ student populations.

What we should be asking, however, is should we have exam schools at all?

Selective public high schools are a rare phenomenon. There are about 165 nationwide—out of more than 24,000—and they are concentrated mostly in Eastern states. Some are nationally known, including Boston Latin School (founded in 1635, it claims to be America’s oldest school), New York City’s Bronx High School of Science, and Fairfax County, Virginia’s Thomas Jefferson High School for Science and Technology. Schools like these are controversial, with battles raging over the perception that they are “elitist,” creating a two-tier society of the well-educated and the poorly-educated—a divide that often falls along racial and economic lines.

The real problem with selective schools is this: They don’t do much good for the kids who attend them. But they deeply harm the children left behind.

To the first point: Selective schools have little real value. Our belief that they do is attributed to what researchers at MIT called the “elite illusion.” They compared two groups of students in Boston and New York: One group had scores just above the cutoff to get into an exam school; the other was just slightly below. If the schools actually educated kids better then there should have been differences in how the two groups performed on things like standardized tests and college admissions. The researchers found none.

Looking at this study as well as others from schools around the country, Susan M. Dynarski, professor of public policy, education, and economics at the University of Michigan, concluded there was “precisely zero effect of the exam schools on college attendance, college selectivity, and college graduation.” And in particular, she called out Boston, saying its exam schools had “zero effect on test scores, including the SAT and PSAT.”

This may seem counterintuitive, especially to parents like me—both of my daughters went to exam schools. These schools typically do better in the aggregate than other city schools on a host of measures, including overall SAT scores and graduation rates. So they have to be better, right?

Not at all. The exam schools appear better because of what academics call selection bias. It’s not the schools that are so great—it’s their students who are great. “Schools can look like they have a large effect on student outcomes,” observed researchers who studied Chicago’s selective schools, “while these apparent successes should actually be attributed to the students themselves.” That’s not to say schools never matter. But students who are already high academic achievers tend to remain that way no matter where they are educated.

It’s not only that exam schools don’t help. By putting all of the most academically advanced students in just a handful of schools, the non-exam schools are far worse off.

This happens in a number of ways. One is simply that children tend to respond to peer pressure. This year, there are 21,095 children in grades 7 through 12 of the Boston public schools. Fully 28 percent of them—5,894—are in the three exam schools (which begin in Grade 7). And what happens to everyone else? “Students are influenced by their peers’ attitudes, achievements, and choices, and if low-achievement students get concentrated in certain schools, a culture of low achievement/low ambitions develops there,” argue researchers Magnus Bygren and Erik Rosenqvist.

Furthermore, there’s the phenomenon of “expectation bias.” By depriving schools of their highest achievers, teachers at the non-exam schools can draw the false conclusion that those who remain are not as smart and not as capable. And a large body of research demonstrates that these kinds of assumptions can, in effect, be self-fulfilling—they “have a causal impact on students’ educational attainment,” say Nicholas Papageorge and Seth Gershenson in a Brookings Institute paper. Not surprisingly, such expectation bias also cuts across racial lines, with data showing that teachers in general tend to expect poorer performance from their Black students than their white students.

Aside from these concerns, admissions to exam schools are deeply unfair. Children from poorer circumstances with parents less able to afford private tutors and exam prep courses tend not to get in—an issue that also cuts across racial lines. Moreover, using achievement when children are only in Grade 6 as a marker of whether they are worthy of an exam school ignores the wildly different ways kids develop intellectually—some more quickly than others—as well as the variety of different learning styles each of us has. Exams and GPAs focus on only one kind of intelligence—the “book smart” kind—to the detriment of the host of others (in 1983, psychologist Howard Gardner proposed eight: logical-mathematical, linguistic, spatial, musical, bodily-kinesthetic, intrapersonal, interpersonal, and naturalistic).

Granted, the exam schools are the Boston public school system’s shining lights. They’re exceptionally well-resourced (check out Boston Latin School’s Harry V. Keefe Library, for instance, or its roughly 30 Advanced Placement offerings, far more than the typical non-exam school), with multiple clubs and activities that offer their lucky students experiences they can’t find in regular schools. But the costs of that approach are high and the solution seems clear: Instead of just three shining lights, we should illuminate them all.

This column first appeared in print in the Boston Globe Magazine on Sunday, April 4, 2021. It is posted on-line at https://www.bostonglobe.com/2021/04/01/magazine/its-time-boston-start-talking-about-closing-its-exam-schools.

We have a great couple of years ahead of us

I know this seems hard to believe, especially with the country still reeling from the death throes of the Trump administration. So why my optimism?

A prediction: We have a great couple of years ahead of us.

I know this seems hard to believe. The country is still reeling from the manic death throes of the Trump administration, which saw violent mobs and allied politicians attempt what could only be described as a coup. At the same time, COVID-19 has surged nationwide. Hospitals in some places are filled to capacity and the country is setting grim records for number of deaths, seemingly every day. The lockdowns have effectively deprived children of a year of education (Zoom is a poor substitute) and left the economy tattered — last year saw some 10 million net jobs lost nationwide. Moreover, those hit hardest haven’t been at the upper rungs of the economic ladder. Rather, it’s been the young, the impoverished, people of color, and women. The gaps between them and everyone else have widened.

So, then, why my optimism? It comes down to three interrelated reasons: a new and far less chaotic national administration, widespread vaccinations, and an explosive economic comeback.

Let’s start with Joe Biden. With a reputation for being calm, reasonable, and empathetic, his rhetoric to date suggests he hopes his term kicks off a period of national healing. There’s no guarantee this will happen, of course — the divisions plaguing the country aren’t suddenly going to melt away. But at least the White House will no longer be fanning the flames. And where once the fear was an out-of-office Donald Trump would continue to command the spotlight, the January 6 ransacking of the Capitol seems to have diminished his power, leaving him Twitterless and an object of increasing revulsion even within his own party.

With a bare Democratic majority, I hardly expect Biden’s term to initiate some set of dramatic new policies — middle-of-the-road senators such as West Virginia’s Joe Manchin probably won’t go along. That’s a good thing, by the way. Right now, what we need is calm, not yet another political war pitting us against one another. Even so, Biden should be able to push through some measures that garner bipartisan support, such as another round of stimulus payments, an infrastructure bill, and a less vituperative trade policy.

He — and we — will also be the beneficiary of the defeat of the coronavirus. The pandemic has been with us for so long it now feels almost routine, like an unwelcome visitor who becomes a permanent squatter. But that visitor will leave — and pretty soon, too. Thanks to Biden pushing the matter, the feds now plan to vaccinate at twice the pace originally planned, trusting Moderna and Pfizer can ramp up production quickly enough to provide the second booster dose when needed. The goal is to get 100 million shots in arms by the end of April — nearly a third of the nation. That’s not enough to get us to herd immunity, but it’s more than enough to immunize those most likely to get sick or die from the disease. Demand on hospitals will ebb, the number of daily deaths will fall precipitously, and by early summer normalcy will begin to return. Restaurants and bars will reopen, we’ll take long-delayed vacations and pack sports arenas, and schools and colleges will welcome students back to their halls.

And the economy will take off like a rocket. Anticipation of this can be seen in the stock markets but, unless you’re one of the very few who can live off their investments, that hardly puts food on the table. Only a job will. Biden’s promised pump priming (including a new round of $1,400 checks to most citizens) will help, yet real growth — and real jobs — will only come when we begin to work, play, and live as we did before.

We won’t do so as completely as we did before. The lockdowns in response to the pandemic have taught us some valuable lessons. A lot of work can be done remotely, and businesses and their employees aren’t simply going to return to the daily grind of commuting. Work-life balance has been reset and many will be reluctant to — and won’t have to — give up the pleasure of spending more time away from the office.

I’m not necessarily saying, in the words of Franklin D. Roosevelt’s old campaign song, that “Happy Days Are Here Again.” Indeed, for many people of color and those at the economic margins of society, the days weren’t happy in the first place. But having been down so long, for many it’ll certainly feel like that. And things can always get worse: the economy might fall into recession, the divisions among us may drive us still further apart, or some new crisis — even another pandemic — might again upend our lives.

Or perhaps not. This is an exceptional moment, a chance to simultaneously leave behind a worldwide health crisis and a poisonous presidency, to use new focus and the new wealth generated by a surging economy to address our ongoing inequities. It’s a unique opportunity. May we seize it.

This column first appeared in print in the Boston Globe Magazine on Sunday, January 24, 2021. It is posted on-line at https://www.bostonglobe.com/2021/01/18/magazine/three-reasons-why-i-know-we-have-great-couple-years-ahead/.

Ranked Choice Voting Failed. ‘Jungle Primaries’ Might Be Our Best Hope For Fair Elections

Just because Question 2 lost doesn’t mean there isn’t a problem with the way we run our elections.

The ballot initiative, you may recall (and if you don’t, all is forgiven — it does seem so long ago) proposed something called “ranked choice voting.” It was urged as a solution to the concern of politicians winning elections even while getting less than a majority of the vote. The initiative was backed by tons of money — much from outside the state — and had the support of seemingly every Bay State politician of note, with the exception of Governor Charlie Baker. Meanwhile, the opposition was almost non-existent and had little funding.

The result seemed forgone — we’d follow the path of the great state of Maine, which had adopted just this sort of thing four years ago.

Except the voters rebelled. Question 2 lost by a convincing 55% to 45%.

I voted with the majority. Ranked choice voting seemed far too convoluted to me, requiring voters to come to the polls not only knowing who they wanted to win but also knowing who would be their choices for second, third, fourth and so on. And it held out the real possibility — which actually did occur in Maine two years ago -- that the pol who got the most “first-choice” votes could nevertheless lose.

Still, consider the case of the Fourth Congressional District. With Joe Kennedy III making his ill-fated run for U.S. senator, the seat opened up in 2020. Nine Democrats were on the September ballot. Jake Auchincloss eked out a razor-thin 2,033 vote victory over Jesse Mermell. But what’s most striking is that Auchincloss received only 22.4% of the vote. Mermell got 21.1% and the other candidates divided up the rest. And because the Fourth Congressional District is true-blue Democrat, the general election in November was a non-event — Auchincloss’s win was a sure-fire thing. Auchincloss in effect was elected with less than a quarter of the vote — and in a Democratic primary as well, where Republicans and independents (unless they same-day enroll as Democrats) don’t even vote.

This was the situation that ranked choice voting was supposed to fix. But there are other possible solutions.

One is used in Georgia, and we’re about to see it in action this January with both of that state's U.S. senatorial positions. Georgia holds runoffs if no one gets a majority of the vote. The problem with special elections such as this, however, is that turnout tends to be low. General elections attract lots of voters, drawn by the many positions on the ballot. Special elections tend to bring out only the most committed, leaving behind the rest of us who perhaps aren’t so fiercely partisan.

The best solution, I think, is called "jungle primaries." Also called "preliminary elections," "nonpartisan blanket primaries" or "qualifying primaries," these elections are used in a handful of jurisdictions around the country. California recently adopted jungle primaries, but the closest to home is in Boston. The mayor and city councilors have been elected in jungle primaries with great success for decades. In 2013, a dozen people ran for mayor. All of them (notwithstanding party affiliation) vied for voters’ favor in the September preliminary. The top two vote-getters (Marty Walsh and John Connolly) then faced off against each other in the November final. Walsh won.

Would any of this make a difference? In the case of the Fourth Congressional, there’s good reason to believe a face-off between Auchincloss and Mermell would have resulted in a Mermell victory — much of the fragmented field seemed more inclined toward her brand of politics.

But it isn’t only the result that might change. Preliminary and final elections force candidates to build coalitions. They need to reach out to their defeated opponents, seeking support. They are forced to appeal to a majority of voters, making the case for why they would be the best choice.

All of this may seem a little arcane, but there are good reasons to care about a majority of voters actually electing a representative. As we’ve seen in the case of the Electoral College, a candidate who wins the presidency without also winning a majority (or even plurality) of the vote lacks some level of legitimacy. Democracy depends upon the consent of the governed. Jungle primaries help us get there.

This column first appeared November 30, 2020 in Cognoscenti.

I wrote about losing my wife to younger-onset Alzheimer’s. This is what helped me feel less alone

People who had also lost loved ones to dementia wrote to me in droves, showing me the importance of community.

Alzheimer’s disease creeps up slowly. A spouse or parent misplaces the car keys. They forget the PIN to the ATM. They get lost taking a walk, struggling to find their way home. First dismissed as nothing — a “senior moment” if you will, something that happens to everyone — quiet suspicions build. A visit to the doctor is arranged. The news comes back. It’s dementia.

And one looks into the abyss. Of the millions who have had Alzheimer’s dementia — more than 5 million Americans are living with it now — none has ever recovered. But it is the path toward death that feels especially tragic. The victim becomes increasingly frail and dependent, unable to manage even the simplest tasks of everyday living — cooking, bathing, toileting. Worse, one of the people you love most in the world — a partner, friend, sibling, or parent — disappears before your very eyes.

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I write from experience. Earlier this year, I recounted in the magazine the journey of my wife, Laurie, through what’s called younger-onset Alzheimer’s — when the disease strikes someone under 65 — a journey that began with her diagnosis at age 56 and ended seven years later with her death, in March 2019. The article provoked an outpouring of responses from readers, many of whom told of their own harrowing encounters with the disease. The fear, heartbreak, and even despair they described reminded me of my own reactions as, bit by bit, Alzheimer’s took my wife. But in an odd way, hearing from them was gratifying, too. The long process of losing a loved one to Alzheimer’s and other forms of dementia can be a deeply personal, isolating experience. Knowing there was a community of others who bore the same hurts made me feel less alone.

Particularly moving to me were the stories of those closest to loved ones afflicted with dementia, who found their lives upended as well. “The impact on family and friends is huge,” says Dr. Alvaro Pascual-Leone, senior scientist at the Harvard Medical School affiliate Hinda and Arthur Marcus Institute for Aging Research, and medical director for Hebrew SeniorLife’s Center for Memory Health. That’s especially the case for those who become the patient’s primary caregiver. Their roles in life shift from being a spouse, son, or daughter to something entirely different. It’s a role they never sought but one they can’t avoid. And as much as Alzheimer’s ravages the minds of those afflicted with it, so too does it ravage the lives of caregivers.

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Early on, for the caregiver there is a basic fear of the unknown. Most of the newly diagnosed seem only slightly different from their original selves. Many still work, some can still drive. Conversation — perhaps not as scintillating as before — can still be had. But the storm clouds are visible.

Mona (I’m only using first names to protect the writers' privacy) told me her sister had just been diagnosed. “Still, for now, she is our sister and knows us and still has most of her essence. I am not looking forward to that going away.”

Polly wrote that her husband was “at the early phases of this challenging disease. . . . I appreciate what my husband still has,” she said, even as she looked forward anxiously to the years to come.

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Susanne’s husband was diagnosed with younger-onset dementia. “To be truthful, much to my later sorrow,” she recalled, “at first, I was just irritated that he wasn’t acting correctly. Later on, when I knew the diagnosis I went into a panic.”

“I hate feeling so powerless,” said Gustavo, whose mother was in the early stages of Alzheimer’s.

“Powerless” is particularly apt. With most diseases, there is a sense that a cure or at least a remission is possible. Not so with Alzheimer’s. When I heard from those who were in the early months and years of dealing with the disease, I’d always write back. But in truth I had little to offer up aside from what seemed like trite advice — “Be strong,” “Reach out to family and friends.”

All true, I suppose, but none of which, I knew, would avoid the pain ahead.

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Eventually the disease progresses and the demands on caregivers grow. Many struggle to maintain their lives; others are forced to place their lives on hold. The stress can be enormous. Caring for someone else 24/7 is hard and often unrewarding work, with no hope that the effort will be rewarded with some sort of recovery. Caregivers are “living two lives at the same time” — their own and that of the patient, says Nicole McGurin, family services director at the Massachusetts/New Hampshire Chapter of the Alzheimer’s Association. It can be especially difficult on spouses. “Sadness and fear mark their days. There’s a lot of uncertainty, not just about the end point, but about how it will progress. Meanwhile, they are grieving for the loss of a spouse, well before she or he is gone. Each new loss in cognitive abilities brings new grief.”

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I remember it well. One day, I suddenly realized my wife could no longer write. I adjusted myself to that, grieving and then reconciling to a new normal. A few months later, she no longer knew who my mother was, and the grief bloomed anew.

Caregivers also grieve for “the loss of the life they once envisioned,” says Dr. Julie Brody Magid, clinical director at McLean Hospital’s Memory Disorders Assessment Clinic. “That’s what I hear from folks in their 40s, 50s, 60s. Some of it is about the loss of a life plan” — careers, travel, shared moments — “as well as losing their partner. ‘We used to talk, run things by each other about children, about our home.’ That reciprocity is permanently altered. Physical intimacy is often changed or may simply be gone.”

Colleen’s husband, Chris, was diagnosed with dementia at age 55. The couple still had a young son at home. “I miss our life. I left my job to care for him. We sold our home but are able to rent a home close by,” she wrote. “We try to make things as normal as possible for our 12-year-old. There’s lots of laughter in our home. As time goes by, we see fewer of our friends. With each change my heart becomes a little more sad. . . . I know what’s coming.”

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“I have to dig deep every day to keep things positive and on an even keel,” wrote Mardy, whose husband was diagnosed more than five years ago. She struggles “to find and validate over and over that life is good and love prevails.”

For others, however — myself included — the work of at-home caregiving becomes too much. They seek out some other solution. Sometimes that can be adult day care, with the patient spending the night back home. But as the needs grow, many seek a full-time solution. For those with the money, that perhaps can mean 24-hour, in-home care. For most, though, it means moving their loved one to a memory care facility or a nursing home.

Nikki wrote that she was starting to look in that direction. Her husband has younger-onset Alzheimer’s. “He is currently home,” she said, “but we are in the process of looking at long-term care facilities. I may not be able to keep him home much longer and dread the process.”

Indeed. The guilt of “sending someone away” can be almost unbearable. “Tomorrow [my wife] goes for her ‘meeting’ at the memory care facility that will likely/hopefully become her new home,” wrote Chris. “My heart is breaking.”

All of this stress directly impacts caregivers' mental and physical health, says Brody Magid of McLean. “They develop a range of medical problems; they frequently struggle with depression and anxiety. The disease in effect claims a second victim.” In fact, one study found nearly 1 out of 5 Alzheimer’s spouse caregivers predecease those they care for, often because the caregivers are ignoring their own needs.

Moreover, dementia doesn’t just cause a loss of memory. It can exert dramatic — and sometimes scary — changes in behavior. “Personalities change,” Brody Magid continues. “People with dementia can have memory distortions that fuel paranoid delusions. They can’t understand why one of their belongings moved from one place to another, so they assume that someone stole it. They may fail to recognize their spouse or children, thinking those people are imposters. People with dementia can become aggressive and socially inappropriate.”

Paula’s husband, a police officer, “got so combative that I was afraid in my own house to be with him alone.” Eventually she placed him in a memory care facility. “I have never had so much guilt in my life! I always told him I would keep him with me but now it wasn’t safe.”

Ellen had a similar experience, watching her mother change before her eyes. “She has gone through periods of being darn right nasty, calling us and her aides ‘jackass,’ ‘stupid,’ ‘dum-dum’ and often swatting at us. It takes patience to see it’s her own brutal frustration that causes these outbursts. Some days it’s easy to find love and compassion, other days it’s hard to understand.”

The disease also takes a financial toll. For those who have to leave their jobs to become caregivers, the hit to incomes is hard to manage. So too is the cost of care, whether it’s in-home, adult day care, or residential. The sad truth is that traditional health insurance doesn’t typically cover the costs of caring for someone with dementia. Long-term care insurance can help, but it’s expensive and, by the time you know you need it, the insurance company would no longer sell it to you. And government-paid care — such as Medicaid — is usually only for those with almost no resources.

The well-off, of course, have more care options. But the “in-betweeners” — as the Alzheimer’s Association’s McGurin, calls them — have few.

“We’re just now trying to figure out long term care for [my mother],” wrote Celeste, “and are shocked by the cost — $10,000 a month — which we can’t afford but . . . it’s what we have to try to figure out somehow. It’s cruel to slowly watch someone you love disappear before your eyes and then feel like there’s no affordable support or solution.”

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The pandemic has only made an impossible task more impossible. “Even in the best of times, we struggle with caregiving and with getting support for caregiving,” says Pascual-

Leone. “During COVID-19, that support is even harder to get. The sense of isolation and loneliness has grown and become even worse.” Videoconferencing is challenging for those with dementia. During the shutdown, outside-of-the-home alternatives — such as adult day care — were unavailable. And folks rightly fear the risk of catching COVID-19 by placing a loved one into institutional care.

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And then there’s the end.

“I don’t know which has been harder,” Charles wrote about his wife, “when she doesn’t know who I am, or when she recognizes me but only for a few seconds. . . . As a clinical psychologist, I recognize I am struggling with anticipatory grief. She is now on hospice (because she does not eat) and rationally I know that what was once ‘imminent’ is now rushing at her — and me. There are days it is not ‘anticipatory grieving’ but I am in a tsunami of anger and confusion and resentment.”

Jane wrote of her mother: “It was as if she was being hollowed out, emptied. It was an ongoing, relentless, and aggressive attack.”

His wife’s Alzheimer’s, recalled Edward, “was like a long tunnel. Living a day at a time became mandatory.”

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After all this, what?

It’s presumptuous to say there is any “right” way to deal with Alzheimer’s disease. Each family circumstance is unique; each of us has our own journey. But the consistent message from the folks who see the disease every day is that caregivers and other loved ones do not have to feel alone. And being a caregiver is not just a burden, but can also be a “gift,” argues Pascual-Leone, a gift that benefits not only the one suffering from the disease but the caregiver, too. He’s right, I’ve come to believe: For it is in caring for others that we can sometimes realize our greatest potential as human beings.

That’s not to say a caregiver doesn’t often feel alone, however, nor that the work isn’t hard or disheartening. Indeed, the role of caregiver can become all-consuming. Sometimes I felt as if it were the only thing I could think about, not sure of the course of my life afterward.

“Despite the grief and loss, we move forward,” wrote Maria, whose husband died from Alzheimer’s.

Philip, sounding positively Belichickian, observed, “It’s not the life we want, it’s the life we get.”

And Joan wrote that she “felt so overwhelmed by the years of the disease, that I found it hard to remember my bright, vibrant, kind-hearted husband. I can’t tell you the number of times I wished he had cancer instead of dementia.” But then she added, “The blessing and curse, for me, of losing my spouse to dementia is that, because I grieved my loss throughout the illness, I felt ready for a new partner even before my husband died.” She admitted that made her “feel incredibly guilty.” Yet, she said, “New love does not in any way diminish the love you had.”

Like Joan, after I had lost my wife, Laurie, I began dating. Much to my surprise, I fell in love. Three months ago, we got engaged. Carla can’t replace Laurie; she never would want to. But as everyone who’s ever had a second child knows, love is not a zero-sum game. Every day, I think about and mourn Laurie. Every day, I think about and cherish Carla.

GET HELP: The Alzheimer’s Association has a 24-hour Helpline, offering resources, care managers, and counseling. It can be reached at 800-272-3900.

This piece first appeared in the November 1, 2020 edition of the Boston Globe Sunday Magazine and be found on-line at this link.

When a COVID-19 vaccine finally arrives, the government must make people take it

Polls show enough people are unwilling to take the vaccine to prevent herd immunity. We can’t let that happen.

Sometime over the next few months, the federal Food and Drug Administration could announce that one of the many vaccines now under development has proven safe and effective and is ready for widespread use. Then comes the hard question: Should the government force citizens to take it?

The answer is yes.

I expect anti-vaxxers are gearing up to lead the resistance. There will be cranky voices against the vaccine — not unlike those noisily protesting Governor Charlie Baker’s flu vaccine requirement. Some will take time off from promoting their flat-earth views to denounce science and espouse conspiracy theories. And, if President Trump announces a vaccine before the election, many people will question it.

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I don’t put it past Trump to use a vaccine to help himself get reelected, but if it is just a political scam, then doctors, researchers, and regulators will denounce it as such. The big pharma companies have made clear they won’t rush things, as well. To write a vaccine off as fatally flawed even before it’s been released is to be no better than the flat earthers.

Here’s a reasonable scenario. As Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has pointed out, no vaccine is ever 100 percent effective. The hope is for one that is 75 percent effective, but even a vaccine that triggered an antibody response in more than 50 percent of recipients would be acceptable.

A coin flip’s chance of being protected? That may seem low, but it should be enough. Here’s why: The public health goal is to achieve herd immunity — when enough people are safe from the disease (either because they’ve had it or because of a vaccine) that it begins to run out of possible victims. What’s “enough” people? Scientists aren’t sure — some say as low as 50 percent but the consensus seems to be 60 to 70 percent.

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Despite the vast numbers of folks who have already had COVID-19 — including the president — we are nowhere near herd immunity. Officially there have been around 7.5 million cases in the United States (as of October 7). Those who’ve survived — about 7.3 million — make up merely 2.2 percent of the population. Researchers in a Nature study of April data, however, suggest testing issues including lack of access mean the real number could be as much as 9.5 times as high. If this undercounting has held true since, it might mean that as many as 21 percent of us have had it.

A lot. Not enough, though, for herd immunity.

But coupled with a vaccine that’s even only 50 percent effective, we can get there. If administered to nearly everyone, the vaccine plus existing immunity from 21 percent of folks who might have already had the disease means that more than 60 percent would be immune (the total is less than the sum because you don’t want to double-count the 7.3 million people who have already had it). Hurray! We’ve got herd immunity — or at least are very close.

Unless, of course, people refuse to take the vaccine. A recent poll found even if our doctors said it was safe, only 62 percent of us would take it. Many Americans, especially people of color, are justly suspicious of a medical system rife with past abuses, or have other reasons to be vaccine hesitant. Others simply fear the new or distrust the government. Still, if almost 40 percent of people decline the vaccine, we won’t even get to 50 percent immunity, meaning an ongoing pandemic.

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All of which suggests the key to ending the pandemic will be to have near total vaccine compliance.

Can the US government really require that people get vaccinated?

Sure it can. But first, there’s a powerful moral argument that needs to be made: The vaccine isn’t about you. It’s about everyone else. Those who refuse to get the vaccine will in effect be imperiling the health and lives of their relatives, friends, and fellow citizens.

Sounds persuasive to me. Still, against all reason and morality, I expect some — maybe many — will refuse. Some will have good reasons, such as compromised immune systems. To help ease concerns from communities of color, the government will need to be transparent about the vaccine and about past misdeeds. For the good of all, we will have to cajole and compel the rest.

We don’t, however, have to start forcibly administering shots. All we have to do is follow Baker’s lead. His flu shot mandate — done so flu cases coupled with COVID-19 cases wouldn’t overwhelm hospitals — shows the way. Baker basically ordered that anyone going to school must get a flu shot. Outside of medical or religious exceptions, it’s “Don’t get the shot? Can’t go to school.”

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The same model can be used for the soon-to-come coronavirus vaccine. Want to go to work? Get vaccinated. Want to go shopping, eat inside a restaurant, or get on a plane? The same. Indeed, the simple requirement can be that if you want to leave your house, you must get vaccinated. Maybe that seems intrusive. But it’s actually far less so than what we endured at the height of the lockdown from mid-March through mid-May, when the state shut down its entire economy.

Maybe a few diehard anti-vaxxers will resist and simply stay forever in their homes. Fine by me. As long as they can’t mix with the general population, they won’t pose any threat. While normalcy returns for the rest of us, and we work and play as we used to, they can stay stuck inside, isolated and alone, glaring out their windows as life passes them by.

This column first appeared October 18, 2020 in the Boston Sunday Globe Magazine and can be found at this link.

What if the lockdown is worse than the disease?

Past disruptions have meant vicious long-term consequences for schoolchildren and the unemployed.

"You’re putting profits before people!” That’s the cry of outrage we hear from those who push back against efforts to reopen the economy, restart schools, and get people back to work.

But this isn’t about money and greed. It’s about people. Yes, the lockdown has saved lives. But in so doing it’s damaged and may eventually take many others. Perhaps the right way to think about our response to the pandemic is that we chose the lives of some people over others, and in so doing, we very well may have calculated wrong.

The harm to children is obvious. Schools across the United States shut in mid-March and never reopened. Our substitute was online education. As I expect just about every parent and guardian now agrees, it’s an ineffective alternative. Indeed, for the youngest, online learning is essentially impossible; they simply don’t have the intellectual tools to be able to engage with teachers through a computer. (Conflict alert: I work for an early-education nonprofit.)

The result has been a missed semester. The damage from skipping a third of a year’s education is likely impossible to fix, especially for those in elementary grades or preschool. Learning for young children is different from adults — the brains of the young are uniquely plastic, absorbing new ideas in succession. But the research is clear that when young children miss even brief windows of learning, it can’t be made up. As the years wear on, we will see a generation of children permanently stunted in their intellectual growth. The Brookings Institution estimates that the school closures so far will cost the affected children $2.5 trillion in lost earnings over their lifetimes. Brooking compares the lost semester of 2020 to gaps in schooling during World War II, saying that those gaps “still had negative impact on former students’ lives some 40 years later.”

oreover, the fallout from missed schooling will land hardest on those from the most difficult circumstances. Wealthier parents have more resources to try to make up some of their children’s loss during the shutdown. Poorer parents are far less able to do so, meaning that one other result from the “pause” (the euphemism used by New York Governor Andrew Cuomo) will be widening inequality, largely along economic and racial lines.

It’s not only intellectual growth and equity that will be lost. Schooling — and the independence from home that it brings — is critical for social and emotional growth. Teenagers and college students are missing activities such as dances, sports, and dating. These are not trivial extras; they are core to a child transitioning to adulthood. So too are friendships and romances without parents’ watchful eyes. Instead, teens and college students are stuck at home, subject to the authority of mom and dad, babied once again. This pause, too, will echo through their lives.

Also feeling pain are the millions of unemployed. The unemployed are not, generally, telecommuting white-collar workers. Rather, they are those on the lower rungs of the economic ladder — blue-collar and service workers — as well as recent graduates new to the workforce and unable to secure jobs. The pain they feel is not only financial, but emotional.

Many of them will face permanent damage from our deliberate economic self-immolation. Some of that damage will be to their careers. Jobs — just like learning — tend to build on one another. The waiter becomes the manager becomes the restaurant owner. The lockdown has interrupted that progression; The Economist predicts the unemployed will face “a lost decade.”

Some of that damage will manifest itself in folks’ physical and mental health. Numerous studies find that unemployment leads to higher mortality (from suicide, stress, and other causes). One, from 2003, found that death rates for the unemployed rose from 5.36 percent to 7.83 percent in the 10 to 17 years following their initial job loss. If applied to the 33 million Americans who had lost their jobs through April due to the lockdown, that means an extra 815,000 deaths — far more than will likely be killed by COVID-19.

I suspect that, long after the pandemic is over, social scientists and economists will be analyzing the multiple unintended consequences of our Draconian response to it. The young and the unemployed will be first on their lists, but there will be others, too: Entrepreneurs whose dreams have been dashed, those not suffering from coronavirus who are afraid to go to a doctor or hospital, the isolated and alone falling into depression and addiction, those trapped in abusive households.

People speak of a second or third wave of infection from the virus — and the instinct from politicians and public health authorities will be to have yet another round of lockdowns. But the point of flattening the curve, as population health expert Drew Harris has said, wasn’t to reduce the number of total cases (no matter what the curve, we’ll have the same “number of new cases over time,” he says). Rather, it was to make sure health care systems weren’t overwhelmed.

We’ve done that. And having done that, this fall schools need to reopen, jobs need to return, and we need to move toward some semblance of an open society. The disease will continue to ravage us, and the losses will be visceral and terrifying. But delaying our return to normalcy will make the costs even worse.

This column first appeared on-line in the Boston Globe Magazine on May 27, 2020 and appears in print in the May 31, 2020 issue.

The thrill of city living is gone

Maybe a takeaway from the coronavirus is that the suburbs really are better.

One possible lesson from the coronavirus pandemic: Maybe the suburbs really are better.

I live in downtown Boston, in a too-small place for too much money. But the argument I always made to myself was that it was worth it. There was the energy and intellectual ferment of folks packed together. There were culture, sporting events, and nightlife right outside the door. Instead of chain restaurants, we had cool little bistros and chef-driven haunts, the better to stretch the palate.

Well, that’s all gone.

The building I’m in used to have amenities like a workout room and roof deck. They’re now shuttered because of stay-at-home orders imposed to stem the spread of COVID-19. Increasingly, that’s true for parks and other recreational areas. Walking outside is discouraged anyway, and if you do, the state has ordered you to wear a mask.

Meanwhile, my friends in the suburbs find the pandemic quite a different existence. For one, most have yards and decks. They can lie in the sun, throw a ball to one another, and pretty much live out their lives normally. Sidewalks are generally uncrowded; social distancing is relatively easy. And, of course, given that a dollar spent on a suburban home buys two to three times the space as in a city, suburbanites have room to roam. (The median price per square foot in Boston is $758, according to real-estate website Zillow; for the rest of the state it’s just $269.) They don’t have to work from home at their kitchen tables; instead they can simply turn the extra bedroom into a home office.

In addition, and perhaps most important, people in the ‘burbs aren’t running the same health risks as those in the city. Pandemics spread when people are near one another. Sure, I’m behind the four walls of my apartment, but going outside for groceries means riding the elevator with other residents, walking through a crowded lobby, and making my way down narrow sidewalks.

In the suburbs, folks just get in their cars. Perhaps suburban grocery stores are as dangerous as Boston’s, but the trip there is a lot less risky.

Someday, of course, the lockdown will end and we’ll eventually be able to venture out of our homes. But even so, the city will probably be the last to loosen its strictures; the governor is looking at reopening in mid-May or June while Boston Mayor Martin Walsh is talking summer or fall. And when that happens, strong remnants of social distancing will remain. No more crowded bars, restaurants, or food halls. Hanging out in coffee shops will be discouraged. Full stands at Fenway and the Garden may never return. All of this will remain in place until the disease is genuinely conquered, either through herd immunity or a vaccine.

Still, after COVID-19 is but a memory, the fear will probably remain. We’ve learned a big lesson from the coronavirus: Pandemics are real, and they can happen to us. Doubtless, another one looms. We don’t know when, but the epidemiologists who have been warning us for years will now be taken seriously.

It’s too bad. Over the last decade, Boston and other urban areas have seen a resurgence in their populations as people moved in, seeking the excitement only a city can provide. Boston, for instance, built entire new neighborhoods — such as the Seaport District or the revitalized Fenway — adding more than 75,000 residents over the last 10 years. Does that continue? I doubt it. The thrill of city living is gone, perhaps never to return. Couple that with our newfound fear of crowds, and I expect we’ll soon see urbanites heading out to the suburbs they once disdained.

This column first appeared in the Boston Globe on May 4, 2020.

How could my wife have Alzheimer’s? She was only 56.

She was the wittiest, smartest, and most talkative person I had ever met. And now all of that was fading away.

It’s a Sunday morning and my wife and I are arguing about the previous night’s dinner party.

“No one would let me talk,” Laurie says.

“What do you mean? Of course they let you talk.”

“No. They’re all just talking constantly and I never get a chance to say anything.”

“But Laurie, that’s what happens at dinner parties. You’ve got eight people fueled by a lot of alcohol and they all are clamoring for the floor. That’s just the way it is.”

“I didn’t get to speak. I hated it. Why won’t they let me speak?”

I’m puzzled. Laurie was always the life of any get-together: raucous, loud, leading the room from one topic to the next. What was going on?

At another dinner party a few weeks later, I notice Laurie sitting back, silent. “Hey Laurie,” I say in a loud voice. “Anything you’d like to add?” The room quiets and everyone looks at her.

“No,” she says, and sips from her glass of wine.

The next morning we’re arguing again. “No one,” she says, “would let me speak.”

____________

I’m sitting in the living room in 2011, reading.

“He’s coming over with the stuff to do the thing,” Laurie says.

It takes me a moment to realize she’s speaking to me. “What?”

“He’s coming over with the stuff to do the thing.”

“What stuff? What thing? And who is he?”

She glares at me. “You know.” The words are accusatory and full of weight.

I wonder if I am becoming that stereotypical husband who ignores his spouse, just responding “Uh-huh, uh-huh.”

“I’m sorry. I must not have been paying attention. Who’s coming over?”

She turns and walks out of the room.

____________

We’ve flown to Washington to visit our oldest daughter, Lauren, at college. We get together for drinks with one of my brothers. “She’s doing the thing pretty soon,” Laurie says.

“What?” my brother asks. “Laurie, seriously, we need to find out what’s going on with your speech. Something’s up.”

Laurie looks shocked, and says, “What do you mean?”

“Your speech, the way you talk. I don’t understand what you’re saying.”

She laughs. “Oh, that’s nothing. It’s the beer.”

When Laurie gets up to go to the restroom, I say to my brother, “You’ve been noticing it?”

"Everyone’s been noticing it,” he says.

“I thought it was just me.”

____________

Worried, I reach out to Laurie’s primary care physician, asking her to refer Laurie for tests. She talks to Laurie, who eventually agrees.

When we meet with a neurologist at Massachusetts General Hospital to find out the results, he says Laurie has “primary progressive aphasia of the logopenic variant.”

"What’s that mean?” I ask.

“It’s aphasia” — an inability to communicate — “and it’s specifically word-related. That’s the ‘logo’ part. Laurie’s having trouble finding words. That’s our primary diagnosis.”

Then he says, “And it’s progressive.”

“Progressive?” I ask.

“Meaning it’s going to get worse.”

I’m bewildered and want to know what caused it. Did she have a stroke? Heavy metals, pesticides? He says probably not, but can run more tests to check.

“Well, I think we need to,” I say. “Right, Laurie?” She nods.

“This is just crazy,” I say. “She’s only 56.”

We stand up and the neurologist asks me to stay behind for some paperwork. As Laurie waits outside, he says, “I didn’t want to say it in front of her, but in all likelihood what she has is younger-onset Alzheimer’s. It just started in a unique part of her brain — the left rear lobe — but like all Alzheimer’s, it eventually will spread throughout the entire brain.”

“You need to prepare yourself,” he adds.

Alzheimer’s? I thought that only happened to people in their 80s and 90s. “But she’s only 56,” I repeat. “She’s got her MBA in finance.”

____________

Laurie and I had first met at a punk-rock club in Washington, where I’d moved for work in 1982 after graduating from law school. I was there with friends when she walked in, 5 foot 11, tan, wearing a black miniskirt. I spent the evening glancing her way, occasionally approaching but then backing off, certain she was out of my league. Toward midnight, I finally went up to her and managed to say “Hello.”

Giving me a withering look, she said, “Well, it took you long enough.”

I was smitten.

She would turn out to be the wittiest, smartest, and most talkative person I had ever met. And now all of that was fading away.

____________

We’re at the National Institutes of Health in Bethesda, Maryland, walking into a small conference room to meet with a neurological researcher. Months earlier, Laurie had agreed to be part of his study testing whether a combination of certain dyes in the bloodstream and positron electron tomography imaging could pick up the presence of abnormal amyloid proteins in her brain. This is a marker of Alzheimer’s disease, usually only found in an autopsy.

The researcher is hoping his technique can detect Alzheimer’s before death. We’re hoping he’ll tell us her increasingly apparent aphasia is caused by something else.

We sit down. He picks up a piece of paper, looks at it, and then looks at us. He starts to cry.

____________

Laurie is standing in the middle of our living room, sobbing. I go to her and hold her. I don’t need to ask what’s wrong; I know. We just stand there, hugging.

A few days later, I look in the medicine cabinet at Laurie’s medications, Aricept and Namenda, representing the only two types of Alzheimer’s-related drugs on the market. Neither stops the disease, let alone cures it, but they’re thought to help improve cognition. The containers seem full. Too full.

“Laurie,” I ask, “Have you been taking your pills?”

“No,” she says. “I don’t need them.”

“Yes, you do,” I say. “You need them for your Alzheimer’s.”

“I don’t have Alzheimer’s,” she says.

____________

Laurie comes out the front door along with our youngest daughter, Bryn, to see the new Honda CR-V I’m driving.

“I want to try it,” Laurie says. Bryn and I exchange looks. It’s 2015 and I haven’t let Laurie drive for months, finding one excuse or another. But I reluctantly say OK, and we climb into the car, me in the front passenger seat, Bryn in back. I suggest we go to get lunch at one of our regular places, an easy drive on mostly back roads.

At the first stop sign, I remind her to take a right. She immediately starts to go left. “No!” I say sharply, “The other right!”

She takes the next turn without appearing to think. She seems to be doing fine, and I begin to relax. A quarter mile later, at a light, she asks “Where?”

I point to the left, and she turns that way. At the restaurant, she cruises toward a parking spot right in front. I realize she’s about to hit a car to our left. I reach across and pull the steering wheel down so we swerve right, saying “Laurie, stop. Stop!” She does.

“Let me park it,” I say. She gets out, and I get in.

After lunch, I drive home. Bryn and I have a few minutes alone.

“That was awful,” she says. “She shouldn’t be driving.”

Later, Laurie tells me that “it’s the new car. I was fine with the old one.”

____________

Laurie walks into the apartment, her face ashen. “Is everything OK? Did you get the money?” I ask. She bursts into tears. “It’s not working.”

I stand up, go to her, and hug her. “It’s no big deal. Let’s go down and take a look. Maybe the ATM’s just broken.”

We go across the street. I watch as she puts her card in and types her password. The screen reads “incorrect password.” She tries again and the error message flashes once more. “What’s your password?” I ask.

“Umm.”

“I’m pretty sure it’s our anniversary,” I say. “Try typing that in.” The numbers she presses are nothing close to our anniversary.

“Laurie,” I say, my voice rising. “Pay attention. That’s not your password.” I catch myself and try to cool down. I ask her to let me help, and type in the password. A few seconds later she has $60 in her purse.

____________

I’m sitting in our bedroom and I hear the click of a door shutting. I get up and look around. “Laurie?” There’s no answer. I walk outside to the hallway. No sign of her. I take the elevator to the lobby and see the doorman. “Have you seen Laurie?”

“Not this morning,” he says. I run up the stairs and find her between the second and third floors. “What are you doing here?”

She looks at me, bewildered.

____________

She got her MBA in finance in 1986, shortly after we got married. An ardent feminist, she kept her own name and we gave our children both of our surnames. She wrote, acted in local plays, ran film groups, and threw herself headlong into our children’s lives.

I sit and contemplate how much Laurie has lost. She can no longer write. She can’t even sign her own name. The television’s remote control mystifies her. When we go out for dinner, she can’t read the menu. She no longer showers, seemingly afraid of the water. She wears the same clothes, day after day. Her hair has grown ragged and when the telephone rings, she simply looks at it.

I understood the word “progressive” when her neurologist first diagnosed it. But I realize I never really absorbed it, fooling myself into thinking that however she was would remain the same way. When I’d notice some new diminishment, I’d just reorder my thinking, believing that this was now the new normal.

I now understand none of that’s true. I’ve lost her. And she’ll never come back.

____________

I’m nervous. For months, Lauren, Bryn, and I have been talking about a next step for Laurie. I travel a lot for work; I can’t care for her at home anymore. We’re worried about her wandering. After touring places, we settle on Avita of Needham, a memory care facility. Today, June 29, 2016, is the day she is supposed to move.

But Laurie seems completely unaware.

A care manager we hired to help us is at the apartment. “Laurie,” she says, “Tom needs to go on a long business trip. He’s going to be gone for a while.”

Laurie looks terrified. “Do you feel afraid to be alone?” she asks. Laurie nods.

The care manager continues. “I know a place that’s safe and fun and where you get to play brain games. Doesn’t that sound good?” Laurie nods again. “Would you like to visit with me?” Laurie nods a third time.

We go to the car and after a short drive are walking through the front door of Avita. The executive director greets us. Everything has been carefully staged. She and others gather around Laurie, hugging her and talking and leading her down a corridor and past a locked door. She doesn’t turn around to look at me.

That night in bed I realize she’ll never sleep next to me again. Despair washes over me.

____________

I call frequently to find out how she’s doing, but I don’t visit. The idea is to give her time to adjust, to become acclimated.

After two weeks, I finally come in to see her. I’m waiting for the questions — “Where have you been?” “Why am I here?” “Can I go home now?” — and rehearsing my answer — “This is your home now.” I’m preparing for the tears and anger.

There’s none of that. We visit, have a cup of coffee. I talk; she listens. I walk her back to her room, she sits in a chair, and I leave.

This really is her home now.

____________

Nine months later, Laurie and I are sitting in the living room at Avita. “My mother died yesterday,” I tell her. They had been close. Laurie turned to my mom when the children were first born and she felt out of her depth, wondering how she would ever manage motherhood.

Laurie just looks at me and stares.

____________

It’s been a year and a half, and Avita’s executive director tells me Laurie needs more care than the facility can provide. I am not surprised.

When Laurie first entered, she could manage most everything, only needing some persuasion to take her medication or brush her teeth. Now she’s largely incontinent, increasingly needs help eating, and is unsteady on her feet.

Laurie gets in the car with Bryn and me for another ride to another new home, the Hebrew SeniorLife facility in Roslindale. Where Avita felt homey and calm, HSL — as excellent as it turns out to be — has a more frenetic, institutional feel. We take an elevator to the fourth floor and find her room. She’s placid and uncomplaining, seemingly oblivious to her change of circumstances.

A few weeks later, I sit down with HSL’s medical team to review her case.

“Except for Alzheimer’s, she’s probably healthier than most of us,” the nurse manager says.

It’s true. She takes no medication except for those connected to Alzheimer’s. Yet even though the rest of the folks on her floor are older than her by a generation or more, cognitively she’s one of the worst off. For the most part, they can still speak, tell stories, play bingo and trivia, talk about the football game on TV. Laurie, once so vital, can’t do any of those things.

____________

Lauren, Bryn, and I sit in Hebrew SeniorLife’s family dining room in 2018. We’ve picked up subs for lunch and gather around a table, feeding Laurie her lunch. She looks at us, her face brightening. “Who am I?” asks Lauren. Laurie gives no response. “Am I Salem?” That’s one of our cats. “Am I Bryn?”

“B-b-b,” Laurie says.

We’re familiar faces. But does she know why? Does she know I’m her husband? That Lauren and Bryn are her children? I don’t think so.

____________

Three or four times a week, I have lunch with Laurie. I sit next to her and cut up her food, navigating forks and spoons to her mouth, trying not to spill her soup. After the kind of “open your mouth” urging I once gave the kids, she’ll take a bite and chew.

Meat loaf is today’s offering. Laurie takes a bite or two but I notice she’s not really chewing. Instead, she tucks the food away in her cheek. I offer some cranberry juice, usually a favorite, but she swallows only a little.

I look at her closely. Her hair is almost entirely black. Her face is remarkably unlined. I stroke her hair and she pays me no mind, never glancing my way. She’s here, I think, but not really here at all.

____________

I’m out of town for a family wedding, having brunch with Lauren.

“Something’s changed with your mom,” I say. I describe how her eating has become more tentative. “Plus, she’s losing weight.”

“Should I come up to Boston?” Lauren lives and works in New York City.

“Probably not,” I say, not wanting her to take an unneeded vacation day. “Let’s see what the doctor says.”

The next day I’m back in Boston. Bryn and I walk into the dining room at Hebrew SeniorLife, ready to have lunch with Laurie. We scan the room and can’t find her. I see her aide. “Where is she?” I ask.

“We couldn’t get her out of bed today,” the aide says.

Bryn and I go to see her. Laurie glances at Bryn and smiles with what might be some recognition. Otherwise, she seems only semiconscious. When the doctor comes, he tells me she’s not taking in any liquids.

"What does that mean?” I ask.

“Seven to ten days,” he says.

I feel like I’ve been hit in the gut.

He says they could give her fluids intravenously, or put a tube down her throat to feed her. Years earlier, the girls and I had talked about such a moment. Back then we had decided we wouldn’t take any extraordinary measures. That decision, once abstract, now seems almost unconscionable. How can I let her die?

There are tears in my eyes now and I say, “No, I don’t think we should do anything. Just keep her comfortable.”

I call Lauren and tell her she should plan to come up in a few days. The next day Laurie seems fine, resting easily, but the following morning her breathing is labored.

It’s been seven years since Laurie was diagnosed, almost three years since she went to Avita and 14 months since she was admitted to Hebrew SeniorLife. Day after day, the disease progressed almost imperceptibly. But now it’s moving too fast.

The charge nurse warns me Lauren should come. Now.

____________

“Alzheimer’s proceeds slowly, almost invisibly, on its destructive course. It’s like the transition from summer to fall,” I say, looking out at familiar faces at Boston’s Old South Church. “The green leaves turn red or yellow or orange, but we never actually see them change. It’s just that, one day they’re green and suddenly, they’re not.”

“But while leaves turn color over a brief period of time, Alzheimer’s takes years. And that amount of time, those long, long years, sometimes makes it hard to remember the days when the leaves were green, hard to remember the woman we all knew.”

My voice breaks. It’s true. The last seven years have been so overwhelming that I find myself hard-pressed to remember what came before. What was life like before neurologists and researchers and memory care facilities, before halting speech and blank stares?

I sift through photos. The two of us walking in a field. Laurie beaming at our wedding. Her driving a car, sunglasses on, turning with a slight smile for the camera. Catching up with her best friend from childhood. A family Christmas card. She and Bryn mugging for the camera. Lauren’s high school graduation. These are the memories that I want to hold on to, the days when her mind sparkled, her smile was bright, and the future beckoned.

This column first appeared in the Boston Globe Magazine  on January 7, 2020 and was published in the print version of  the Magazine on January 12, 2020.

A Nobel Love Story

As he walked into his lab at the Dana-Farber Cancer Institute, filled with cheering staffers and supporters, Bill Kaelin’s thoughts weren’t on the molecular biology of cancer.

Lying in bed, Bill Kaelin saw it was 6:00 a.m., well past the time the Nobel Prize Committee makes its calls to winners. He thought: Oh well, I guess I didn’t get it. No big deal.

The phone rang. He looked at the clock. It was 4:40 a.m. He wondered. Was I dreaming then or am I dreaming now?

Sometime later, as he walked into his lab at the Dana-Farber Cancer Institute, filled with cheering staffers and supporters, his thoughts weren’t on the molecular biology of cancer. They were instead about love. Love lost. Love found.

Bill was a resident at Johns Hopkins when he spotted Carolyn Scerbo at the faculty pool and thought to himself: That’s the woman I’m going to marry. He did, and they ended up in Boston. He started working as a researcher in the lab of David Livingston at Dana-Farber. Her career was meteoric. A surgeon, at just age 34 she was named founding director of the Comprehensive Breast Health Center at Brigham and Women’s Hospital. Living, as they did, in Boston’s Back Bay, raising two children, and pursuing work each found deeply meaningful, life seemed idyllic.

And then — the irony lost on no one — in 2003 Carolyn diagnosed herself with breast cancer. It was a shock, but “deep down both of us thought she was going to be a survivor,” Bill says. “And she did survive.” The chemotherapy had an unexpected side effect, however: It numbed Carolyn’s hands, leaving her unable to continue as a surgeon. “She didn’t wallow in self-pity,” Bill recalls. “She just decided to direct her energies elsewhere.” She threw herself into becoming a patient advocate, writing two books to help others who found themselves in her situation: “Living Through Breast Cancer" and “The Breast Cancer Survivor’s Fitness Plan.”

“We got to a pretty good life after breast cancer,” Bill says.

But then, in 2010, came a second diagnosis: Carolyn had brain cancer — glioblastoma multiforme, the same cancer that killed Senators Ted Kennedy and John McCain.

Bill got into cancer research, he says, because “I saw too many people suffer.” But “until it happens to a loved one, until you feel it in your soul, you don't fully understand how this disease affects you, turning your world upside down.”

“My entire family had to grow up. Having gone through the scare in 2003 helped us in 2010. We had more coping skills, greater resilience.” Carolyn had the first of two brain surgeries and had to teach herself how to walk again. “I knew and she knew that the textbook prognosis was dismal, but we took comfort that she was at a great place getting state-of-the-art therapy.” They took comfort as well in simple routine: having a care plan and executing it faithfully.

Then too, Bill acknowledges, part of coping was simple denial. "We’d say her case was ‘exceptional,' that she’s younger, she’s had more extensive DNA testing,” he said He remembers them talking about the someday-movie of her life, documenting her hoped-for recovery. “She was going to be played by Julia Roberts.” And him? “Pee-wee Herman,” he offers up with a laugh.

Meanwhile, his own work in cancer research proceeded apace. “The lab became a place to retreat and to recharge.” The ordeal with cancer, he says, “can be very depressing, but you don’t have any choice. You do the best you can.”

In 2014, there was a relapse and a second surgery. Carolyn died in 2015.

Bill threw himself into work and into remembering. And then one day, about two years after Carolyn’s death, he asked someone out on a date. He had a personal epiphany: “I realized it was the first time in years that I allowed myself to look forward in time rather than backward in time.”

Perhaps, he thinks, dwelling on the past was a way to avoid Carolyn’s death. “There was this irrational sense that if you kept looking backward, maybe you haven’t lost this person.”

Still, he thought he would never be able to love again. “The analogy I use,” he says, “is that when I had my second child, I could not imagine that I could love someone as much as my first. But of course, love is not a zero-sum game.”

As he spoke in his lab after being awarded the Nobel, Bill said, “You know, my number one prize in life was my beloved Carolyn, who was my partner and best friend in life.” But he also spoke about the future. I’ve learned, he said, “that maybe I can smile again and laugh again and maybe even find love again.”

I think many of us have this image of Nobel laureates as uber-humans, far different from the rest of us, brainiacs unaffected by the vicissitudes of normal human life. Hardly. Nobel Prize laureates or not, we all live much the same lives: supporting our families; doing our bit to contribute to the world; loving, laughing, and crying through the years.

Kaelin formally receives the Nobel Prize on Tuesday (December 10).

This column first appeared in the Boston Globe on December 9, 2019.

Governor Baker, lift the ban so adults can vape

Mountain climbing is dangerous. Skiing is dangerous. But the long arm of the law doesn’t reach out and say folks can’t climb or ski. There’s a basic logic to this: If you know the risks, and you’re still willing to take your chances, you should be allowed to do what you want. It’s your life, after all.

So why doesn’t this logic apply to vaping?

Two weeks ago, Governor Charlie Baker pushed through a ban on vaping. Although it applies only to those who sell e-cigarette supplies, and it’s for only four months, the net effect for most who vape is that they can no longer engage in the practice. Some are heading to New Hampshire for their supplies, and others might turn to the black market. But for the rest, vaping is no longer an option.

At the time of the ban, there was a near panic over a spate of lung-related illnesses and deaths, all of which seemed to be tied to vaping. Doctors and public health professionals had no idea what was going on and Baker’s ban was borne out of this confusion. The argument was that a ban was warranted because, in fact, no one knew what the risks were.

Fair enough. But the Internet and social media are wonderful things and the fact is that today pretty much everyone — and most certainly vapers — is aware of these once-unknown risks. The news of those illnesses and deaths have been trumpeted everywhere. So does the ban still make sense? If folks want to vape — knowing, as they now do, that they might face imminent hospitalization — shouldn’t they be allowed to do so?

It’s their lives, after all.

I go back and forth on this one, in part because it’s more complicated than just knowingly taking a risk.

For one, it’s an addictive risk. Most vapers use the devices to inhale nicotine, and sometimes at levels far greater than cigarettes. There’s a widespread belief among vapers that vaping doesn’t have the same risks as cigarettes, in large part because they don’t have cigarette cancer-causing tars and other harsh ingredients. But nicotine itself is dangerous, capable of causing much harm, including adverse effects on “the heart, reproductive system, lung, kidney, etc. (as well as) carcinogenic potential,” according to the National Institutes of Health.

Granted, even with potentially addictive substances, we usually let adults make their own decisions. But in the case of vaping, manufacturers — Juul is the prime example — targeted their products to kids, with child-friendly flavors such as mint, mango, and fruit. And those kids, almost by definition, are unable to make reasoned, mature decisions about what risks they should and shouldn’t take. Yet an addictive habit picked up as a teen is extraordinarily hard to shake as an adult. Juul was going as young as it could so it might create a life-long consumer — and that’s appalling.

Still, if we could keep e-cigarettes out of the hands of kids, one could make the case that we should allow adults to vape if they wish. We do so with conventional cigarettes, coupling their sales with grim warnings on every pack. That, it seems, is the direction that Governor Gina Raimondo of Rhode Island went. After Baker put in place his ban, she followed with one of her own, but one that was more narrowly drawn, targeting the flavored e-cigs that most seemed to appeal to kids. Her approach seems to be the more reasoned.

I’m no fan of the industry. I’ve never smoked or vaped. But an essential tenet of freedom is the right to take risks. We don’t have the right to impose those risks on others (hence, bans on smoking in bars or restaurants), but adults — presumably capable of making reasoned choices for themselves — should have the right to impose those risks on themselves. The public health community was delighted when Baker imposed his ban, and I understand why — they see all issues like this through the lens of morbidity and mortality.

But if adults want to vape — and they do so knowing not only the long-term risks but also the potential short-term issues — they should be able to do so. Baker should issue a new ban, one more narrowly tailored to protect kids, and let adults do what they want.

This column first appeared in the Boston Globe on October 7, 2019.