Friday, January 17, 2014

There's Always a First Time

During 2013, I found myself often saying, “There’s always a first time.” For me, this included:

  • Publishing a book.
  • Conducting a funeral service.
  • Traveling to Asia.
  • Undergoing invasive surgery.
  • Spending multiple nights in the hospital.
  • Finding my cyst was cancerous.
After four years of talking about getting a book of my photographs of former Chicago synagogues published, I took some good advice and published it myself on There Used to be a Synagogue Here: Former Chicago Temples debuted in January, containing 100 photographs from more than 500 I’d taken across the city. Circumstances have hindered my promotion efforts, but a page-long article in the JUF News and a sold-out presentation at the Standard Club have helped sell the book and garner many compliments.

My mother passed away on March 26, less than six months from her 90th birthday, after living a very good life. Mom stated several times she didn’t want a rabbi at her funeral service but never put it in writing. I’d thought about going against her wishes but changed my mind in large part because of my rediscovery of the Union Prayer Book, copyright 1924, by the Central Conference of American Rabbis. It was given to my father on June 12, 1932, in honor of his confirmation from South Shore Temple. The book contains a chapter, “Evening Service at the House of Mourning.” And although the funeral wasn’t in the evening and not at a house, I thought it appropriate to use selected passages. Even the cemetery manager complimented me on the service.

The past year wasn’t without its highlights. Janet and I visited Greece, Crete, Israel, Cyprus, Rhodes and Turkey – all for the first time – as part of a Mediterranean cruise. Our three days in Israel were most memorable; we only wish we had more than a half-day in Istanbul but we will go back to both places.
Now to the serious stuff. In late 2010, I was diagnosed with a kidney stone. The single stone was so large it hardly moved, sparing me from most of the pain associated with this condition, and it was mostly dissolved through lipsotripsy. In the course of x-rays, MRIs and the like, my urologist, Dr. William Lin, discovered a cyst on the right kidney. Its Bosniak system rating was 2, meaning a 0%-5% chance of it becoming cancerous. Thereafter I went to Dr. Lin every six months to have some type of imaging done to monitor the cyst. Nothing changed until last November.

By chance, a CT scan with tracer fluid had been ordered for my last visit, a better means for diagnosis than an MRI. The cyst had changed size – shrunk a bit – and composition. The tracer fluid indicated blood flow in and out, and Dr. Lin changed the Bosniak rating to 2F, 25%-30% chance of malignancy. The radiologists recommended waiting another six months, thinking the cyst could simply collapse. Dr. Lin and his partner, Dr. Daniel Dalton, said they’d never seen that happen and recommended surgery, which would remove about a quarter of the kidney with the cyst to ensure there was no spread if it in fact had turned cancerous. The decision was up to me; I told them to proceed with the surgery so it can be over and done and my convalescence would occur during the winter.

The original plan called for laproscopic surgery, using Intuitive Surgical’s daVinci system. One of my better investments was buying ISRG stock at $89, so I looked forward to seeing how it worked. Unfortunately, factors demanded surgery the old-fashioned way, necessitating a 3-5 day hospital stay. The requirement to stay on a low-dose aspirin regimen due to a 2004 angioplasty complicated the procedure because of the increase risk of bleeding.

The surgery, performed by Dr. Dalton at Northwestern Memorial Hospital, took a few hours on December 26, leaving me with an 8-inch surgical scar held together by 20 staples. A quarter of the kidney was indeed removed, and Dr. Dalton said the cyst “didn’t look good,” estimating an 80% chance it was cancerous but adding it looked to be encapsulated. The pathology report, handed to us as we were leaving NMH on December 31, reported a “multilocular cystic renal cell carcinoma,” grade 1 on the Fuhrman scale. There was no spread into the kidney, other organs or lymph nodes. If left unattended, we were told it might grow slowly over time with a minimal risk of spreading. It was still a good thing to have it out, especially when I was “young” enough and strong enough to cope with this type of surgery.

Having only spent one overnight visit to a hospital, this five-night stay was a revelation. I came back from the operating and recovery rooms with a catheter, oxygen, devices that massaged my lower legs to avoid blood clots, IV drips for nourishment and generic morphine (the same type used in the messy Ohio execution a month later), a bulb for blood draining and a sore throat from having a breathing tube inserted during surgery. This type of surgery messes up your entire body, most notably your digestive, plumbing and waste-disposal systems. Blood draws and blood pressure, pulse and temperature measurements were never-ending, including at 3:15 a.m. daily. By the second day, I could get up and begin walking again. Solid food – Jell-O, yogurt and other soft stuff – came on day 3. I may have been able to go home a day earlier but the doctor kept me in to ensure there was no internal bleeding. The nurses, without exception but for the one who didn’t secure the bedside panel, causing me to almost fall out of bed after it collapsed at 3:30 a.m., were excellent.

So 2013 is gone and I’m on the mend, which brings me to two related subjects: preventative medicine and health insurance.

After Janet retired in 2009 and our COBRA coverage ended, I found a preexisting condition precluded obtaining private insurance. My choices were a state risk pool, which offered inferior coverage at a fairly high price, or Janet’s policy from the retired teachers’ association, the same PPO as before but much higher premiums. From annual premiums totaling about $4,500, the new total was close to $18,000. Medicare was still four years away.

Going without insurance was never an alternative, of course, but the investment in this costly medical insurance was well worth it. It covered an arthroscopic knee surgery in 2012 by Dr. Mark Bowen, one of the best in the business, which kept me on the basketball court and provided for the biannual urology visits to monitor the cysts. The insurance paid for itself.

I will conclude with my extreme displeasure about the ongoing debate about health insurance. I believe most the bills are in, except for the three follow-up visits with Dr. Dalton. Including my one-hour pre-op visit but excluding the previous CT scan or doctor visits, the tab comes to approximately $70,000. Insurance reimbursements are not in yet for the hospital stay, which totaled almost $59,000, but for the remaining portion my out-of-pocket is $282.10. I could have paid the full amount if I’d elected to go without insurance but what about those without insurance without $70,000 to spend? Who pays for them?

The Affordable Care Act is designed to provide the small minority of Americans without insurance or severely substandard coverage with the peace of mind the rest of us enjoy. Interestingly, a high number of ACA enrollees are those who aren’t old enough for Medicare who have either lost their jobs and/or are self-employed. Congressional Budget Office studies show the new mandate will neither bankrupt the industry nor lead to “rationing,” which in fact is already done. The persons opposing the ACA will give any number of reasons for doing so but they will never tell you the truth: they are scared to death it will work.

One last anecdote on the subject, for those who “don’t want the government running healthcare.” My late cousin, Dr. Jim Nachman, was one of the foremost pediatric oncologists in the world. On occasion, insurance companies sent reimbursement checks directly to him, for which Jim would simply turn them over to the University of Chicago Hospitals. One day, however, he received a check for approximately $500,000. Now what did I do, he thought, to merit this type of reimbursement? He found it was for a patient who had undergone a stem-cell transplant that required multiple blood transfusions. Somebody keyed each transfusion in as a transplant; the true figure was about $15,000 but the company approved it anyway. Jim then demanded to speak with the president of this major NYSE insurance company. After thanking him profusely for his call, the executive asked if there was anything he could do for Jim. “Why yes,” he replied, “You can make a contribution to my pediatric cancer research fund.” By the way, that fund lives on, continuing Jim’s great work of saving children’s lives.