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Jan. 27, 2010

          I’m writing this with somewhere between one and two kidneys. Not that this interferes with typing, but it can sort of theoretically compromise, oh. . .life.
          It all started with kidney stones, and a visit to a doctor who perhaps thinks he should have been a character on “E.R.” The late-30-ish, brilliant, cool dude with longish locks who saves lives with a laser.
          Dr. Dude will not be named here, because he would certainly sue me, and frankly, he has done enough harm. Unwittingly, unintentionally, yes, but harm is harm. Besides, I’m willing to bet that Dr. Dude plucks stones out of kidneys the way Hillary Hahn plucks a violin, that he is veritable poet of his trade, a renal Rimbaud. That in surgery, he is to kidney stones what the alcalde was to Zorro.
          But he has a thing or two to learn. Or three. And if you are reading, Dr. Dude, pay close attention. I ain't kidneying around.

          I had two stone attacks in late November. For those who have not experienced this ecstasy, it is rather like being hit with a sledgehammer, except the impact does not diminish. It stays constant for hours. It makes you understand why wounded soldiers want to be shot, and why women who have had both stones and babies say that babies don’t hurt as bad.
          So I went to the doctor. It’s what you do when you have kidney stones. Unless you are me, fifteen years ago, when I just rode them out. For six months. I’m now too old to ride.
          Dr. Dude appeared casually, with nearly shoulder-length hair worn back. I thought this boded well. I have often had such ridiculous thoughts. Truth be told, and it seldom is, I liked Dr. Dude. At first. He actually listened to my detailed description of my symptoms, unlike 99.9 percent of other doctors I have visited in my life, and then he said, glibly:
          “I agree with your diagnosis!”
          Next he asked what sort of writing I did, and after I said, “I was a newspaper reporter,” I was barely able to get another word in. Dr. Dude went on a jag, a monologue, a declamation, all about an article in the Wall Street Journal he had just read about Rupert Murdoch. . .
          And what a great man Murdoch is.
          The reader should understand something here: telling me that Rupert Murdoch is a great man is rather like a Holocaust denier telling a Jew that Hitler did a lot of good for Germany. I admire the late, great writer, Dennis Potter, who, when fatally ill, allowed that if he had one more task to fulfill in life, it would be to “kill Rupert Murdoch.” Murdoch makes William Randolph Hearst look like an egalitarian philanthropist, a paragon of journalistic virtue. He is venality and cynicism personified, nothing less than the most dangerous and harmful force in media on the planet.
          Other than that, he’s okay.
          So I gritted my teeth and smiled politely, and said something about how Murdoch probably wasn’t such a good thing for journalism. Which prompted Dr. Dude to disagree! That’s correct, suddenly there was a debate. Go to a doctor, have an argument! “Well, he’s a real newspaperman,” said Dr. D., and I refrained from saying that Madonna is a real composer. I mean, I had gone to the goddamn clinic for help with kidney stones, and was not only getting a protracted speech about Murdoch, but the guy was interrupting me to tell me I was wrong. . .
          While he was giving me an ultrasound exam!
          Yes, folks, my gut was hanging out, all greased up, and he was running his little gizmo over it looking at the stones, while he carried on and on about Murdoch and why newspapers are dying---all in this very cool, calm, what-seems-to-be-the-trouble-today monotone, an almost Xanaxed hum of voice. And then---
         “I just went to Bob Hilburn’s book-signing.”
          Forget that his ideas about the problems with newspapers were ill-informed, amateurish, and off the mark. Forget, even, that he regarded Murdoch as a great man. So does the Catholic Church (which made him a knight after he donated $10 million.) But. . .(former L.A. Times pop music critic) Robert Hilburn? To name-drop Hilburn in “conversation” with me, while running a science-fiction device over my Vaselined midsection? And to carry on about how great Hilburn’s new memoir is? I mean, give me another kidney stone, please.
          To be fair, I suppose, Dr. Dude obviously thought he was making interesting chit-chat in order to put me at ease and take my mind off my troubles. Fine. Except I didn’t want my mind taken off my troubles. I had come to him in order to deal with my troubles. And he didn’t know my opinion of Murdoch, or that I enjoyed working with Hilburn when I freelanced for the Times every bit as much as I enjoy gum injections. Never mind that I think Hilburn was one stinko critic. But. . .
          What are the odds? I had called a kidney-stone brother for a referral to a good doctor, and wound up listening to a worshipful discourse about two of the journalism figures in the world I least admire. Vicodin!
          Still, I overlooked this, and in the end, Dr. Dude informed me that I had one stone stuck in the ureter, which had caused some edema, and one stone “obstructing” the kidney. He gave me some Flomax, a nasty drug that promotes stone passage, and instructed me to get a CT scan in order that he could see things more clearly. The next day, I readily subjected myself to the mini-Hiroshima that this test entails, in order that Dr. Dude might more clearly read my entrails. So to speak. Two days later, he phoned:
          “There are actually five tiny stones in the kidney,” he said in that same Muzak-y neutral hum, adding that they were in the “collection area” and were “not obstructing” the kidney. The large one in the ureter, he added, had only about a 20 percent chance of passing on its own. He said it could be broken up with a laser, and the small ones “grabbed.”
          “It’s like spelunking,” said Dr. Dude jauntily, adding that the stent implanted for a week after the surgery, from kidney to bladder, is “not very pleasant.”
          I asked if this was doctor-speak for “extremely painful,” and he repeated the words “not” and “pleasant.” The only people harder to pry loose from their euphemisms are generals. I cringed over this, but even more at his use of the term, “spelunking.” I mean, I’m glad he might enjoy his job, but my kidneys are not a playground.
          In conclusion, said Dr. Dude, “I recommend that you have surgery in order to avoid long-term damage to your kidney.”
          I asked how soon the surgery could take place, and he instructed me to call his office in the morning to book it. “I can get you in,” he said with what I thought was a touch of boastfulness, “within 48 hours.”
          I must explain here that I do not like doctors. I have been mistreated, abused, misdiagnosed, ignored, administered tests that were unnecessary, given drugs that I didn’t need (which sometimes turned out to cause dry-mouth-headache-diarrhea- strokes-and-even-death), and so on. My body has healed itself from a number of maladies, including three years of Chronic Fatigue Syndrome, with no help from western doctors. (Chinese Medicine doctors, notably the wonderful Dr. Ji-Ling Hu, have been very helpful.)
          And if I had a chance to avoid general anesthesia, doctor/nurse error, the risk of pneumonia, drug-resistant staph infection, etc. incurred during kidney stone surgery, I figured on taking it. So what I heard is this: the kidney was not obstructed, after all, and the stone in the ureter had a slim chance of making a break for it. Still, I was very nervous about the whole affair, so I followed through and phoned Dr. Dude’s office the next morning to book the surgery, just to preserve that option. I wanted to confer with wife and a couple of friends first.
          Dr. Dude’s office aide phoned me back late that afternoon to say this:
          “I’m afraid we can’t book your surgery. The hospital is moving.”
          Yes. Really. The hospital is moving. My dog ate it. Huh? Hospitals move? Which hospital was this, I wondered. St. Alphonso’s Pancake Breakfast General? Dr. Dude works in a very big and reputable facility full of very big and reputable doctors right next to a very big and reputable hospital. The hospital is moving? Huh?
          “It’s moving? Oh. Um. . .”
          “Well, wait a minute. We might be able to get you into this clinic that we sometimes use. . .hold on. . .”
          This clinic that we sometimes use? What, the MRSA H1N1 Clinic?
          “Oh, never mind. I guess we can’t do that. Is your situation urgent?”
         I swear to Florence Nightingale she asked me this. Is your situation urgent.
          “Well, gee. I don’t think I am qualified to make that determination. I think that such an evaluation is up to the doctor, don’t you?”
          “Okay, I’ll have him call you.”
          Which he did.
          The next afternoon.
         Right around the time that he had told me he could “get me in” for surgery. And these were his exact opening words, delivered again in that dispassionate, almost disinterested vocal blur:
          “You wanted to speak to me?”
         Seriously. He really said that. I should have responded, “Right. I wanted to hear you blather on self-importantly about Rupert Murdoch and your pal, Bob Hilburn, you jackass.” You wanted to speak to me. . .No, actually, there was no one in the world I wanted to speak to less, with the possible exception of Tavis Smiley. Still, I played it straight. Dr. Dude instructed me to tell his office manager that my situation was “urgent,” and that had I done that in the first place, she would have booked the surgery.
          My fault, apparently!
          I didn’t ask Dr. D. why in the kidney stones he did not tell the goddamn woman to book the goddamn surgery herself, if it was so goddamn urgent. I goddamn suddenly had about as much goddamn interest in proceeding with goddamn Dr. Spelunking Dude as I have in sitting on the goddamn 405 at goddamn 5 p.m. This was not very pleasant.
          “Well,” I said, “I’ve had a lot of pain in the past year (calcific rotator cuff tendonitis landed me in the ER, where they doped me up with Dilaudid), both physical and emotional, and frankly, I think I’d rather take my chances on passing this thing.”
          Because he is a doctor, whose sworn priorities have something remotely to do with healing people, I knew he would explain further why the surgery was necessary, “urgent,” or even vital. But no, I’m all mixed up in my understanding of doctors, you see. Dude just repeated that it was “urgent,” but not an emergency, and that the situation would not start to become more serious for several weeks. His parting remark:
          “I understand your reasons. I’ve given you my recommendation.” (Or something very close to this.)
          In the next month, my symptoms stabilized and the pain subsided. No more attacks. I went on a program of tinctures, herbs, and liquids aimed at promoting the passage of kidney stones. I took hot baths and popped Flomax and slept with a heating pad. Crazy people offered to heal me by long distance, and I told them to go ahead.
But because I am not totally insane, I got a second opinion.
         “Your kidney is blocked,” said Dr. No. 2, Gerhard Fuchs of the Cedars-Sinai Minimally Invasive Urology Center.
          You will be surprised to learn that Dr. Fuchs never once brought up Rupert Murdoch or “Bob” Hilburn. All he wanted to talk about was my health. Over three  weeks had passed, and he was viewing the same CT scan that Dr. Dude had.
          “Oh, yes, it’s blocked. The stone in the ureter is blocking the kidney.”
          Ah, the stone in the ureter was blocking the kidney. . .
          “So the kidney. . .isn’t working?”
          “That’s correct. It has shut down. The lack of pain is actually a bad sign.”
          I realize that DC-3’s can fly on one engine, Marty Feldman saw with one eye, and people can pee on one kidney---and that perfectly health humans donate kidneys to help ailing friends, even strangers---but you know, I kind of like the idea of having a back-up. It was then that I fearfully realized that the puffiness and dark circles under my eyes were probably a symptom of kidney failure.
          I booked the surgery faster than The Roadrunner disappears after sticking out his tongue. At Cedars-Sinai, which did not appear to be moving.
          And then I phoned Dr. Dude.
          “Hi,” I said. “I just wanted to clarify a couple of things here. “Is my kidney blocked?”
          His voice was, as usual, as indifferent as math.
          “Oh, yeah, the kidney is blocked,” he said, probably filing his cuticles. “You’re now doing moderate to serious damage to the kidney.”
          Really. This is what he said. Blithely. Like he was giving instructions on how to water a lawn. Yawning. He had told me that the kidney was not obstructed by the five stones in the kidney “collection area,” so I had concluded that the kidney was fine. He never said that the stone in the ureter had actually shut down the kidney. This had never occurred to me, especially since he said there was a chance of passing the thing. And he had allowed me to walk away. He had allowed weeks to pass without following up with further information or recommendations. Three weeks when I was doing “moderate to serious damage” to the kidney. Why?
          Because he was not required to.
          He had spoken the legally required “I recommend you have surgery so as to avoid long-term serious damage” speech, which sounded like, “Brush your teeth so don’t get cavities” to me---especially in view of the fact that he told me the kidney was not obstructed, and that he had also given me a sample of the evil drug, Flomax, to promote passage of the stone. Exclamation point.
         Again, he had done only what was legally required. He did not care beyond that. I repeat the key words in the preceding sentence: he did not care.
          I responded:
          “Well, that’s comforting!”
          This set Dr. Dude off. Mind you, his voice remained mild, marshmallowy, but the inflection was unmistakable. Scolding.
          “I told you,” he said. “I told you that I recommended you have this surgery so as to avoid long-term damage to the kidney---“
          “Yes, I know you said that---“
          “I told you. I can read the exact quote to you because I wrote it down.”
          And he read it.
          “Yes, yes, I know you said that.”
          Do you get the picture here? Dr. Dude didn’t give a rat’s ass about my health. All he cared about was covering his own. He had written down the quote as a precautionary measure to protect himself in the event of a lawsuit. And now this overgrown spoiled, rich kid, a one-time graduate of a very monied high school, had the audacity to crow at me, a guy with one functioning kidney, “I told you. . .”
         No, Dr. Dude. You didn’t tell me. Had you told me, I would have booked the surgery faster than a fly blinks. Here’s what you should have told me:
         “The stone in the ureter has blocked the kidney, and the kidney has stopped functioning. If this goes on, you will very soon experience moderate to serious damage to the kidney. You need to have the surgery as soon as possible and I will book it for you within the next 48 hours.”
          You goddamn dumbass.
          Instead, Dude had indifferently recited, “I’ve given you my recommendation. . .” and hung up. After all, he’s a very busy guy packing in as many of those profitable spelunking expeditions as he can.
          The upshot: Dude never phoned back, of course. If I was doing damage to my kidney, what concern of it was his? I had surgery promptly with the excellent, highly professional Dr. Fuchs (who still has not brought up Murdoch or Hilburn), all went extremely well, and the kidney is expected to recover over time.
          Which is more than I can say for Dr. Dude’s communications skill, and humanity.

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