I first saw her the Wednesday after the world shut down. She appeared in the upper right-hand window of my Zoom gallery during a virtual PTA meeting. I recognized her, this woman I’d glimpsed each morning, an OK-looking lady staring down middle age and, until recently, winning that contest — or at least, not losing it badly.

She jogged regularly and had often announced her intentions to remain gluten-free. Pre-pandemic, she had looked fine, and for her mid-to-late 40s, fine was good enough.

But each time I saw her on Zoom, she looked worse. Eyeliner-less, her eyes seemed to bulge, and the dark circles beneath them darkened all the more. Clearly, she’d stopped jogging and had taken to eating gluten; her skin was dry, flaky, loosening. Where did those neck wrinkles come from? Had she always had them? Also: jowls? Already? 

If you haven’t figured out, that woman was me. I would stare at my own face, unable to concentrate on the stories people shared, convinced I was aging prematurely, or at least badly. It helped when I discovered Zoom’s “hide self-view” feature, but by then, the damage was done. Staring into Zoom day after day had changed the way I saw myself.

Zoom fatigue is real and well-documented. It’s psychologically and physically draining to be on camera all the time, unwitting reality TV stars, constantly making eye contact. And we’re not meant to witness ourselves at all times. 

But what I have experienced goes beyond that: the lowering of a few rungs on the self-esteem ladder, which wasn’t that high to begin with. 

There are many horrors taking place in the world right now, more than anyone can list or accommodate or fix, far graver than dealing with my face on Zoom. The pandemic has claimed lives, devastated families, evaporated bank accounts and exacerbated inequality in all forms. It is a privilege to complain about how looking at myself on Zoom has affected me. And yet, though COVID-19 has robbed me of more than my self-esteem, this is a real and insistent part of how I’ve been affected.

After all, like most women, I have been taught that what matters most about us is our looks in a society that rarely focuses on the changing beauty of middle age. How fitting that an app named Zoom magnifies those feelings of insecurity and loss.

I polled people who are similarly struggling.

“Do you have a moment to discuss my chins?” my friend Deborah asked.

My friend Bliss said she thinks about the title of Nora Ephron’s memoir, “I Feel Bad About My Neck,” at least once each workday.

“I space out on Zoom calls, picturing various jowl minimizing gadgets I could invent,” said Catherine.

Melissa added, “I sometimes put a Post-It note over my face. It helps.”

Vanessa, who is Black, spoke of the additional challenge of finding lighting that will properly capture her features since, like so much face-related technology, the app is geared toward lighter skin; there’s a kind of Zoom racism causing her additional distress. 

She started wearing more makeup to emphasize her features, but that, she says, defeats the whole purpose of working from home, which she’s done for 10 years. “Part of the benefit is not having to get dressed and put on makeup and think about how you look,” she said. “Now all these new work-from-homers have ruined it.”

For me, the problem is the compounding of low self-esteem and its intersection with paranoia and self-absorption. I have always felt ashamed of my looks, which I would categorize as exceedingly average with the occasional interruption of cute until I was 40 and had my second kid. That’s when the overarching adjective to describe my face became: tired. I was ignorable. I was fine. 

And fine was good enough, especially when I was able to control the amount of time I spent staring at my face. A glimpse in the mirror, adjustment of the chin, positioning the head to avoid the sagging skin — I wasn’t so continuously confronted with myself the way I am these days, in Zoom life.

Once regularly on Zoom, I wondered how others saw me, if they felt sorry for me that I was aging badly, if they felt sorry for my husband. I wondered if, after leaving the Zoom meeting, they said to their partners, ”She was staring down middle age and now she’s lost that battle.”

They may seem like superficial and indulgent feelings, but consider the real-life consequences of disorders like body dysmorphia: depression, anxiety, self-harm, and, in its less potent versions, annoying the crap out of your spouses. 

At least outside I can retreat into the protective fabric of my mask, with only my bulging eyes visible above the seam. Pandemic upside.

Meanwhile, my 76-year-old father has reminded me that he’d happily trade ages with me. Others have suggested Zoom’s touch-up feature, a filter that apparently offers a virtual facelift, though I fear further distorting my view of myself. 

What I would like instead is to turn on Zoom, and see my friends, my students, my comrades, and just not care about how I look. So many women in their 40s get to this mythical land I’ve heard about, where they “don’t give a fuck.” About anything. I have tried to find the train to that land and it’s just not running from wherever I am.

Or I’d love to turn on Zoom and find beauty in the face staring back at me, to think, “You’ve been through a lot. You’re still here. That in itself is beautiful. Also: Think about other human beings now.” 

And some days, I do. Some days, even without hiding my self-view, I’m able to concentrate on the millions of things more important than the transformation of my face or to realize what a luxury it is to complain about it.

Those days, I’m more than a slightly foreign-looking face in a box. I’m a friend, sister, daughter, colleague, trying to connect in a world gone mad, and gone online. Those days, I remember, with a pandemic stealing so many lives, to see aging for what it is: a gift and a privilege. 

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My guard was down when the caller ID lit up with the number from my mom’s care home on March 28. The ringing phone interrupted the time my husband and I were enjoying together over our coffee, a rare delight and an intentional moment of “looking on the bright side” of social distancing. I woke up that morning feeling like we were finally getting into a groove after more than two weeks into isolation. The days no longer stretched in endless minutes with constant interruptions. My mind had transitioned from shock toward acceptance. The breathless “what if” scenarios and endless emails starting with  “in these unprecedented times” had receded to the background. 

The disjointed words “your mom, vomiting, ER” tumbled through the line, echoing against the noisy rush of blood in my ears. My next words should have been, “I’ll meet her ambulance there,” followed by a scramble to grab my keys and race to the hospital. Instead, I was engulfed in stunned silence. 

Since my mom was diagnosed with Alzheimer’s disease seven years ago, I have been her primary caregiver and advocate. She once told her friend, “The kid will tell me what I need to do — she takes care of everything!” She had forgotten my name, but was certain of my capable care. 

I knew I would walk my mom to the end of her days on this earth, to the very end of this challenging Alzheimer’s journey, and she knew it, too. And I realized that in doing so, in fulfilling my duty to her and living my love for her, I would experience many heart-wrenching moments. I already have. I sat with her when the doctor said, “I think Alzheimer’s is causing what you are experiencing,” and I watched through tear-blurred vision as my mom’s face reddened in protest.

I hired her caregivers and fielded her calls when she didn’t want “these people” in her home. I bore her teasing tone when she called me her “handler” or replied in a sarcastic tone, “OK, Mommy,” to my directives. I signed do not resuscitate (DNR) orders. Eventually, I visited memory care homes and made the decision to move her in. Many difficult decisions are part of the slow, steady decline of Alzheimer’s. But never did I imagine that I wouldn’t be by her side when she needed me. 

When I hung up the phone, I knew implicitly that I would not be allowed to visit my mom at the hospital because it was very possible that she might have the coronavirus. As of March 18, the hospital my mom was sent to had stopped allowing visitors except under specific circumstances (like hospice). While nominally one visitor is allowed per emergency room patient “if necessary,” in practice no one advertises that. The hospital is fighting a war with an invisible enemy, and the risk of community spread is too great. The likelihood of the coronavirus being present within an ER setting was enough to prevent me from even contemplating going. However, because my mom is unable to understand or produce words anymore, I knew she would not be able to communicate with the medical staff, and without me ― her voice and advocate ― she would be confused, vulnerable and entirely alone.

I had no window into what was happening in the ER except for the lab results I received by email throughout the morning. Since my mom’s medical account is linked to mine, notifications containing these jolts of data kept arriving but without any context or explanation. For three hours, I heard nothing else. I tried to wait patiently, tried to stave off the nagging nervous ache in my stomach, tried not to jump to conclusions and hope that some IV fluids would make her healthy again. I had to assume she was receiving good care, even though I couldn’t put a face or name to any of the nurses or doctors. I couldn’t see her or talk to her. I could only imagine the hospital gurney she lay on, the colors of her hospital gown, and I wondered if she was warm enough, if she was scared, what the room looked like and how often the monitors beeped. A headache blossomed from my neck to the tip of my brain — intense, deep and throbbing. 

I finally called the ER when I could no longer keep my anxiety at bay. The doctor reported that she was rehydrated but coughing, and her X-rays showed mild pneumonia. He was testing her for COVID-19 and would admit her for monitoring. 

But what could I do now? The die had been cast. She was on a gurney, sick and confused, rolling through an unfamiliar and frightening place, where she would stay until that coronavirus test came back. Would it be two days? Three? More? This chain reaction of events already felt so far out of my hands. For all my promises to be by her side when she needed me, for all the advocacy I’ve done on her behalf for the last seven years, I found myself in this moment merely miles away but a world apart. 

At 7 p.m. my phone rang again, this time with the hospital’s number on the caller ID. The doctor introduced himself as my mom’s attending physician and said he was calling to let me know that my mom’s COVID-19 test was positive. He said the prognosis for patients who are my mom’s age and who have her cognitive condition was not good, and that I needed to consider expanding the scope of her DNR if she took a turn for the worse. For the second time that day, silent streams coursed down my cheeks. I called my brothers to tell them to prepare for the worst. 

Just before bed, the dread, sadness and fear crept its way in more aggressively. Sleep became elusive, exhaustion battling with imaginings of my mom’s reality. My eyes quickly became sunken underneath bags of fatigue so large an airline would have charged me for extra baggage.

Isolation had never felt so complete. The notion that she might pass away wondering, in her lucid moments, why I had abandoned her destroyed me. I couldn’t do anything, not tell her I loved her or even hold her hand. This separation from connection, from any semblance of normalcy, is one of the most unimaginably inhumane and thoroughly vulnerable times of most of our collective lives. All of us are struggling with enormous amounts of uncertainty in this COVID-19 world. In my mom’s case, the tsunami of sick patients was already starting and the medical staff was overwhelmed. How could I empower myself and advocate for my mom from afar? How could I exercise power where I could?

I needed to find a way to connect with her, so I started by reaching out to my Facebook community. I asked if anyone knew people who worked at the hospital where my mom was admitted, hoping to find a direct connection to my mom. Then, I sent my mom’s lab and hospital reports to a doctor friend. She helped me interpret what I was seeing and gave me the language for what I needed to ask during the doctor’s infrequent check-ins.

What else could I do? My mom was combative and refusing to eat. I was sidelined. I tried not to bug the nurses. But she is my mom and it is my job to ensure her welfare. I called twice a day. My mom is so visually connected that I didn’t think a phone call would do much. But we tried it. A nurse caring for my mom passed the phone to her. She didn’t say much, but I could hear her voice and her raspy breathing. I told her I loved her and that I was sorry she wasn’t feeling well.

I don’t know if it helped, or if she understood, but it made me feel better. She heard my voice, and that was a small joy.

And then, I connected with a friend of a friend who worked at the hospital, and I asked her to please tell my mom that her daughter loves her. Even if she may not understand it, I wanted her to hear it. I needed her to know that. If it’s her time, I can make my peace with that. But I wanted her to know I love her and would never have abandoned her.

Being able to get this message to my mom changed everything for me. 

Personal connection, even without physical contact, is enormously important. I have had a glimpse into the inhumanity of being pulled apart, how it tugs at your heart and empties out your soul, how it makes your head want to explode and how the feeling of something being amiss never leaves you the whole time, through every action of every day, even as you try to carry on.

So far, my mom has made it through the dicey early days of a COVID-19 infection, but even two weeks in she still has the virus. All of her caregivers must dress in full personal protective equipment, enhancing the sensation for her, surely, that aliens have taken over and removed anything familiar from her world. Few care homes are accepting coronavirus-positive dementia patients. Due to these “unprecedented times,” the rules are being written on the fly. With the hospital in desperate need of patient beds, for more than a week she sat mostly alone in a hospital room but couldn’t be discharged because there was nowhere for her to go.

There are no guarantees in this journey of life. Never before has that been so universally apparent. I’ve learned that it’s important to try to figure out ways to empower yourself and creatively strategize in order to diminish uncertainty and powerlessness. As I sat in an existential crisis on the sidelines while my mom navigated hospitalization alone, I discovered that I am scared and worried, but I am not helpless. In this moment of our collective history, as we weather the storm of this public health crisis, we may feel helpless, but we must also be resourceful, compassionate and courageous.

I did everything I could for my mom with what I had access to. And now with my mom back in her care home, I am enjoying seeing her on FaceTime and look forward to being able to visit her again when this isolation period is over. I am still hoping that she recovers fully from this, but I have to remind myself that whatever happens, she won’t remember this. I will.

A HuffPost Guide To Coronavirus

Illustration by Sara Andreasson for HuffPost

This story is part of Pain in America, a nine-part series looking at some of the underlying causes of the opioid addiction crisis and how we treat pain.

With age comes pain. Whether caused by injury, arthritis, cancer or any number of conditions, persistent pain affects up to four out of every five people age 65 and older.

While many turn to opioids and other medications, their risks, including the potential for abuse and overdose, are well known. Less well known (at least among the general public) are the added issues older adults can face when taking these drugs.

“The older you are, the more likely you are to develop an adverse side effect from a pain medication,” said Cary Reid, associate professor of medicine in the division of geriatric and palliative medicine at Weill Cornell Medicine and director at Cornell’s Translational Research Institute on Pain in Later Life (TRIPLL).

Those side effects, such as confusion and a heightened risk of falls, can be severe and can make doctors hesitant to prescribe pain medications to older adults. These drugs can also take longer to metabolize with age, meaning they can be more potent or stay in an elderly person’s system longer than expected. And because many older adults take other medications too, there’s also the risk of problematic drug interactions.

With the number of American seniors expected to almost double by 2060 — to nearly a quarter of the population — this all adds up to a growing need to find alternative treatments.

That’s where researchers like those at TRIPLL come in. One of 13 Roybal Centers that the U.S. government’s National Institute on Aging has funded to improve the lives of older Americans, TRIPLL focuses on nondrug approaches to managing and preventing chronic pain.

It’s casting a wide net, looking into alternatives that range from acupuncture and meditation to physical therapy, cognitive behavioral therapy and even mobile technologies.

In one TRIPLL-funded project, Elizabeth Murnane, a postdoctoral scholar in the computer science department at Stanford University, and a team of researchers developed smartphone-based technology that adults 55 and older can use to self-report the intensity of chronic pain. The idea is to capture information about pain as it happens without burdening the patient, while serving as an alternative to pen-and-paper and verbal self-reporting measures commonly used in clinical settings or at-home methods that often suffer from low adherence or misreporting.

The test used nine different measures to capture the patient’s experience of pain, including a circle that fills with color when the interface is touched, and a widget for reporting pain with a numerical range of 0 to 10 that can be adjusted by tapping the screen. Early testing revealed some usability issues for older adults with low digital skills or motor, cognitive and visual impairments, so the researchers changed the design to be more touch and pressure-oriented, “in part motivated by how we’d sometimes observe our participants instinctually grasping the hand of a loved one or a chair or other object nearby in moments of pain,” Murnane explained. 

Now Murnane and her collaborators are working on a pain assessment tool that examines rhythms of pain intensity. 

Many factors can influence the experience of pain — age, gender, genes and how much sleep a person needs (and how much they actually get), Murnane said. “Healthy functioning and synchronization of the circadian system is known to deteriorate with age, contributing to a vicious cycle of sleep disruption and exacerbated pain in older adults.”

The researchers hope the data can be used to advance the basic understanding of pain and how it manifests in everyday life — behaviorally, psychologically and physiologically — as well as to design new tools for pain monitoring and management. For example, they hope to discover digital biomarkers of pain, which are bits of data collected with digital devices and wearables like smartwatches that can be used to explain or predict the presence of illness or disease. In Murnane’s case, these markers could be someone’s degree of forward flexion or how far they’ve walked on an inclined path, which researchers expect would correlate with pain severity, she said. 

Negative emotions are also associated with chronic pain — typically, the more depression, anger, negativity and irritability that a patient feels, the more pain they report experiencing, Reid explained. 

Weill Cornell Medicine psychologist Dimitris Kiosses and a multidisciplinary team of researchers have been working on a psychosocial treatment called “problem adaptation therapy” that aims to provide elderly patients suffering from chronic pain with techniques — like deep breathing, relaxation and changing their perspective on a situation — to decrease the impact of negative emotions and increase the impact of positive ones. 

“The goal there is to have people recognize the kinds of emotions they experience and to develop strategies to minimize negative emotions, because research has demonstrated a strong link between negative emotions and increased pain and pain-related disability,” Reid said.

Barbara Chase, an 81-year-old New York City resident, learned valuable techniques for managing chronic back and nerve pain she experiences from Parkinson’s disease by participating in this program. She’s never liked taking medicine, she said, and is amazed by how helpful some nondrug alternatives — like listening to music and relaxing her body and mind — can be in managing pain. Chase now likes to go to the gym, turn off the lights, and listen to music through her phone while stretching and doing other movement exercises, which she says takes her to another place. 

“It makes me relax and I just forget,” Chase said. “I don’t think about it.”

Relaxing by lying on the floor, closing her eyes, and spreading out like a bird has a similar effect, she said, adding that she can often feel her pain coming on ahead of time, and now knows to use these emotion-regulation techniques to get rid of it. 

“It’s amazing,” she said. “And it’s free.”

Older adults with HIV are a growing population with high rates of chronic pain and substance use, and decreased physical function. To address these issues, researchers supported by TRIPLL developed an eight-week behavioral pilot study in 2016 that incorporated weekly tai chi and cognitive behavioral therapy sessions and used text messaging to facilitate behavior change.

Results from a small randomized control trial were positive — participants who took part in the CBT, tai chi and texting program experienced more pain relief, reduced substance use and improved physical performance compared to a control group who received standard care. Now the researchers are trying to obtain funding from the National Institutes of Health to support a similar but much larger trial.

Because many clinicians were trained to manage pain primarily with medication, educating them about nondrug approaches to pain management can be difficult, Reid said.

Another challenge is getting insurers to cover nonpharmacological pain management techniques, and without insurance coverage, many treatments become inaccessible for patients who can’t afford the out-of-pocket costs. 

Even finding places that offer those alternatives can be tough. “It’s often difficult in New York City, and if it’s difficult in New York City, imagine what it must be like if you’re living in a very rural state,” Reid said. “We’ve got to enhance the availability and dissemination of these kinds of tools.” 

Joe Biden, the third-oldest candidate in the 2020 presidential race, has faced questions for months over whether he would limit himself to serving one term in the White House if elected. With varying force, he has denied any such intention. 

According to a Wednesday morning Politico report, however, the 77-year-old former vice president has “revived” the one-term debate among his closest advisers and is signaling that he would “almost certainly” not run again in 2024. 

“If Biden is elected, he’s going to be 82 years old in four years,” an unnamed adviser told Politico, “and he won’t be running for reelection.”

But the candidate himself said Wednesday that the report was pure malarkey. 

“I don’t have any plans on one term,” Biden told ABC News when asked about the Politico report, which he called “just not true.”

Kate Bedingfield, a Biden deputy campaign manager, chimed in over Twitter to deny it, as well.

“Lots of chatter out there on this so just want to be crystal clear: this is not a conversation our campaign is having and not something VP Biden is thinking about,” Bedingfield wrote.

Biden has appeared less certain in the past. In an October interview with Associated Press reporter Meg Kinnard, he seemed to be considering the possibility of a one-term presidency. 

“I feel good and all I can say is, watch me, you’ll see,” Biden said at the time. “It doesn’t mean I would run a second term. I’m not going to make that judgment at this moment.”

Age has cropped up repeatedly in the 2020 race as a raft of candidates vie for the Democratic nomination to challenge 73-year-old President Donald Trump. 

The oldest candidate, 78-year-old Sen. Bernie Sanders (I-Vt.), also refuses to say he would limit himself to one term ― even after his recent heart attack.

Former New York City Mayor Mike Bloomberg at 77 is second-oldest ― born the same year as Biden, 1942, but several months older than him. Sen. Elizabeth Warren (D-Mass.) is 70.