Chapter 8 - Afflictions

In my 88 years of life, my body has changed considerably, but it has never asked permission before doing so. My knees, my eyes, my hands, my hearing, some of my bones, and my memory have all deteriorated. These changes are not betrayals; they are just what bodies do when they are hurt, overused, or as they age. These are not misfortunes; they are just the consequences of living. When they occur, I must determine whether my next step is to accommodate or restore. I usually choose restoration, which has included psychotherapy, much medication, many supplements, numerous operations, two different pairs of eyeglasses, two hearing aids, and two knee replacements.

My weight has always been an issue. I think about how much I weigh every morning as I head to my scale, and every time I sit down for a meal or even think about having a snack.

My Hazardous Appetite

At nine months of age, I weighed 38 pounds. My first diet consisted primarily of bananas. No kidding. Right at the gateway into my oral stage, my mother put me on a diet of bananas. I wonder what Freud would have said about that. Even before I can remember, I must have known that appetite was hazardous.

9 Months Old

But the diet apparently worked well, because at the age of three, I weighed 37 pounds.

3 Years Old

My eating habits growing up were not very healthy. I remember frequently eating alone in front of the TV, generally on a large piece of paper rather than a plate. I was particularly fond of non-kosher submarine sandwiches (also called hoagies, heroes, grinders, or wedges). My mother was a kosher caterer and wouldn’t let me in the kitchen with those sandwiches. I had no problem eating alone. There were no eyes to notice what I ate, how fast I ate, or how much I ate. I always worried about not having enough to eat.

I remember having occasional meals at the kitchen table, but I can’t remember my father or mother sitting there with me. My mother would always be standing, always in an apron, always holding or picking up one of the many utensils or cooking implements covering the table, and always asking me if I wanted more of whatever I was eating.

My mother had a spectacular culinary reputation. She was a terrific cook – everybody who remembers her remembers her that way. Even kids my age loved her food; some of my old friends still talk about it to this day. She would cater events for hundreds of people, all from this little kitchen, not more than six by ten feet. She was especially famous for her blintzes, which she made by the thousands. I wrote a poem about those delicacies: Here is that poem:

A Stealth Bomber

I loved those blintzes, but, in retrospect, given decades of weight problems and high cholesterol counts, I’m certain that my longing for blintzes and similar foods did me in. As an adult, my weight constantly fluctuated. I had an exceedingly difficult time keeping my weight down, especially after I discovered my enormous affinity for free food, particularly on buffet tables. My low point (or high point, if you want to plot my weight) came at age 47, when I was both the Commissioner of Mental Health in Westchester County and the Chair of the Westchester United Way Campaign. With those dual responsibilities, I attended three to four annual meetings or fundraising events each week, and each one with plenty of food.

Almost every event had a buffet table. Some people learn to avoid these fattening, generally unhealthy spreads. I learned just the opposite: I was a stealth bomber, able to stand by the table and shovel food into my mouth without anyone noticing. At many of these events, there were no tables; the guests circulated, and when speeches were made, they simply stood in place listening. I learned to position myself at the buffet table before the evening's presentation began, unless I happened to be the speaker. This ensured that all those I considered culinary competitors would be locked in place listening to speeches, and, for that time, the buffet table was mine. But even though people couldn’t see me consuming that food, I couldn’t conceal my weight gain.

At the beginning of that year, each member of the Westchester United Way Campaign Cabinet was fitted with a jacket bearing a United Way logo, courtesy of Neman Marcus. By the end of the year, I could not fit into my jacket; I had gained more than twenty pounds. By year-end, the jacket had become an unavoidable source of embarrassment. Not being able to button my jacket was uncomfortably noticeable, showing how out of control my eating had become.

Me and My Knees

It was obvious that weight gain required dramatic, even drastic, calorie-depleting countermeasures. Once, for example, as described in Chapter 7, I took a solo 10-day bike ride to Trumansburg, New York, and back. During that bike ride, I lost fifteen pounds and felt and looked good. But trying to maintain that desirable weight was punishing and demoralizing. I could almost hear the pleadings of all the deprived fat cells I had nurtured by the age of nine months, urging me to be realistic, find the nearest buffet table, and dig in.

For a while, I tried to outrun the possible weight gain, literally. I tried long-distance running.

Long Distance Running

That kept me looking good and even improved my mood. But running put considerable stress on my knee joints and wore down the cartilage. My knees became increasingly worse, and at the beginning of 2015, 34 years after that momentous bike ride to Trumansburg, I made an appointment to see an osteopathic physician.

“I can’t believe you’re not screaming,” he said, during my third appointment, twisting my right leg and then my left with escalating compression. The remaining discussion went something like this:

“You might need to have your knees replaced sometime, but not right now.”

“Why not,” I replied.

“Because they don’t hurt enough.”

That makes no sense, I thought, looked at him, and said, “I don’t understand.”

“There are still some things we can try that are not so invasive, and we should give them a chance to work.”

“But I don’t like the way I feel.”

“I know, but you can still get around without much difficulty. When you can’t, that’s the time for a major operation like this one, which, by the way, doesn’t always turn out perfectly.”

He was reluctant to recommend an operation, but I did not share his reluctance. Nevertheless, I shrugged my shoulders, nodded, and closed my eyes as the orthopedist gave me the third in a series of steroid injections.

As I was leaving, he said, “Keep on doing whatever you’re doing.”

What I was doing was consuming twelve different anti-inflammatory supplements every day. I was also keeping the pressure off my knees and protecting the muscles around them, skills I learned during my involvement with the Alexander Technique. For example, I would lift myself out of chairs by pushing up with my arms until I was almost upright, then pushing out to complete the lift.

But life was a continuous struggle, a seemingly endless series of taxing encounters. I was living in Brooklyn in a three-story walk-up. Each workday, I walked a half block down a steep hill from my house to the subway station, then two flights down to the platform, often finding it more difficult to walk down than up. I always had to stand while waiting for the train to arrive, then stand at the next station, where I changed to a second train that was usually so crowded I rarely got to sit down. Having bad knees is an invisible disability, so I was never offered a seat. It was difficult to keep my balance because of the train's sway as it sped from station to station. Moving along, the trains would start and stop unexpectedly, pitching me forward and back. As passengers entered the train and jostled for position, bodily collisions were frequent, and elbows did their best to move me forcefully out of the way. When I reached Manhattan, I had to climb two flights of steps from the subway platform and then walk almost six blocks to my workplace. There, in a building without an elevator, I had to climb a long stairway to reach my office on the second floor, a stairway I used several times a day to access the bathroom, our conference room, or grab lunch. At the end of the workday, again at rush hour, the commute would repeat itself in reverse, down the hill, two flights down to the platform, two trains to Brooklyn, two flights up to street level, and a steep climb up the hill to my house.

The area around my knees was frequently throbbing, and my lifestyle was distressing. I never exercised and felt flabby. Standing for extended lengths of time was fatiguing, and sitting for extended lengths of time was stiffening, so when I got up, I walked like Victor Frankenstein’s monster. I had begun climbing and descending all the steps like a toddler – one step at a time. I looked and felt like a very old man.

I’d had enough. I contacted a highly recommended surgeon at the Hospital for Special Surgery in New York City to discuss a knee replacement. Because of my age – 77 at the time – I couldn’t have both knees replaced simultaneously, so I agreed to have them done sequentially, a process that would consume six months out of whatever lifetime I had remaining. Pre-operation X-rays showed that my legs were in parentheses. I gave my employer a month’s notice.

On the day of the operation, my wife and I were escorted to the presurgical holding area, where I was provided a revealing hospital gown and where I met my surgeon for only the second time. He marked my right knee and told me I was in good hands, and I believed him.

I don’t remember the operation itself except for being wheeled in and looking up at the masked face of the anesthesiologist looking down. He told me to start counting, and as I did, my mind briefly reviewed my health proxy and living will. Preparing these documents in a lawyer’s office was fairly perfunctory, but wondering if the anesthesiologist’s eyes, mask, and voice would be my final memory was very scary. But I survived and was considerably relieved when I woke up in the recovery room,

After a little while, I was conveyed, as if a package, to an inpatient unit. Soon, a physical therapist came by, got me out of bed, fitted a walker to my height, and got me moving. By the next day, I was practicing step climbing. On the third day, I was discharged. They gave me a prescription for OxyContin, a strong opioid. In retrospect, the hospital seemed cavalier about how many pills they would prescribe. They told me to call before I ran out, and they would send me another prescription. This was before the opioid crisis hit the news, and at the time, I didn’t recognize the dangers involved. I used the drug whenever I experienced or anticipated pain, like when scheduled to go to physical therapy. Since I had two knee operations, my convalescence and consequent drug use stretched across six months. I’ve often thought about how easily I could have slid into addiction.

A few days after arriving home from the hospital, nurses and physical therapists began to show up, and rehabilitation started in earnest. I walked as much as I could, using recorded Marine Corps drill instructor cadence calls to discourage sauntering.

My next step was to get myself to an outpatient physical therapy center. I didn’t need a cane, but I carried one to help me get a seat on the bus. After one particularly painful session, my therapist had me on my stomach with my knees bent, and he would push my lower legs down toward my back. It hurt like hell, and I couldn’t avoid screaming.

Throughout that period, I frequently needed to ice my knee and did so while lying on our sofa, watching videos, almost exclusively The West Wing. I had already seen all 156 episodes during its seven seasons twice, and as I iced, I watched them all twice more.

Back then, many people were afraid to have their knees replaced one at a time because they thought the first one would be so painful that they wouldn’t want to suffer the second. But I felt terrific and was anxious to get the left knee done as soon as possible. The second operation took place about three months after the first. When I had my physical, the hospital internist smiled and told me that my BMI (Body Mass Index) was now normal, not because I had lost any weight, but because my right leg had straightened out, and I was taller. The second operation was easier because I was familiar with the routine. While icing my knees for the second time around, I watched all seven seasons of The West Wing twice more, bringing my complete series total to six, or almost a thousand episodes. I love that show and still watch it.

My knee replacements were life-changing. Once rehab was completed, I walked without pain or any difficulty whatsoever. Here is an X-ray a new knee:

One of my new knees

The Limits of Belief

The knee replacements were two of the 13 serious operations I’ve had so far. The most serious took place in July 1998. I had been feeling well as I went for my annual physical. But a week later, I received an alarming telephone call from my primary care physician.

“Your PSA is elevated,” he said. “We need to draw more blood for another analysis.”

The following week, after he received the results of the repeated test, he called again. “I wouldn’t worry too much about it yet. Could just be an enlarged prostate. That often happens.” And then, he referred me for a biopsy.”

His third call was terrifying. “The result of the biopsy is 'positive,' he said, a contronym I will never get used to. I knew what 'positive' meant.

“How bad?”

“Your Gleason score is 8. That means, there’s a fast-growing cancer inside you.”

With the receiver cupped in my other hand, I sat down. When people said the word cancer in 1998, they lowered their voices, sometimes whispered. When I finally tried to put the receiver down on its base, it slipped from my hand. My wife overheard the call and said, “We’ll do whatever we need to do.”

After reading everything I could find about the illness. I knew I was ready for the operation, but I worried about letting friends and family know. I particularly didn’t want to alarm my children, who were then young adults. I knew that worry was inevitable, and what I hated most was putting them into the awkward position of having to reply. One of my daughters reacted with what sounded like anguish. My face contorted hearing her, and, for a brief moment, I regretted calling her.

Responses from friends and other family usually began with, “How are you feeling?” My usual response was the very clichéd “as well as can be expected.” I grew tired of saying that, but could not come up with anything better.

Some compared my prostate cancer with more lethal conditions, implying that I was lucky. Lucky was not one of the words that popped up as I thought about what was happening to me. But I never said to myself, “What did I do to deserve this,” like many people do, when confronted with a serious illness. As a practitioner of A Course in Miracles, I did not believe in divine retribution, a belief that underlies that statement.

I gave serious consideration to treating my prostate cancer holistically. But then doubt took over. My belief in mind-body interaction notwithstanding, I had no confidence that meditation, guided imagery, biofeedback, lifestyle changes, or similar practices would have any effect on the cells of my prostate. Alternatively, I believed that traditional medicine had a high rate of success with prostate cancer. It was one thing to try alternative approaches with back pain or ulcers, but cancer, I thought, was too potentially catastrophic to fool around with.

My daughter, Lisa, worked in the pharmaceutical industry and knew many people who knew many doctors. She had recommended the surgeon who did my knees, and she had learned of a doctor considered by many to be one of the best, if not the best, urological surgeons in the city. I had ruled out radiation therapy, thinking that, because of my work, I would be too busy to take the one-hour trip from southern Brooklyn to and from upper Manhattan for a prolonged period. I called the recommended doctor and set up an appointment.

Further examination disclosed that I also had a pouch on my bladder and several hernias, probably from all the heavy lifting required during the restoration of our 104-year-old three-story brownstone, described in Chapter 1. My surgeon could take care of all three problems at the same time, but he said the operation should take place as soon as possible because of my high Gleason score.

I told him I couldn’t do it right away because the same daughter was getting married within the month. I had learned that the operation can cause urinary incontinence, at least temporarily, and, as I put it, "I'm not about to walk her down the aisle or have a father-daughter dance wearing smelly old Depends." The surgery was scheduled for nine days after the wedding.

In the meantime, I had to go to the hospital to donate blood, to have it available in case I needed a transfusion during the operation. As a mental health professional, I was convinced that physical illnesses are not all biologically based. I believed that my mind could, in fact, create physical illness and, by implication, I believed my mind could rid the body of whatever was ailing it. I asked the phlebotomist to take a little extra blood so I could get another PSA test. She did, and this time, the results came back normal. I also had an appointment with my primary care physician to get a pre-op clearance, which was used to assure the hospital that I was healthy enough for surgery. I told him about my normal PSA and asked him to repeat the test. It too came back normal. I concluded that the same mind that had created the cancer had also gotten rid of it. I was convinced I was cancer-free and was smiling when I told my surgeon about the normal PSA tests.

He said that a PSA is a good indicator, a good starting point, but not very accurate. He said that because of the biopsy, he knew I was seriously ill. But, understanding that I was ambivalent, he suggested that the operation on the bladder pouch and the hernias should take place as scheduled, and once I was opened up, they would do a more thorough biopsy and evaluate from there. I agreed.

After I was anesthetized and opened up, the surgeon took more tissue from my prostate for the biopsy. In the meantime, he dealt with the other two problems. When the biopsy results came back, it showed that the cancer was much worse than originally thought. Much worse! The radical prostatectomy went forward. – I didn’t know that because I was asleep at the time. But when I woke up in the recovery room, my entire prostate was gone, my cancer was gone, and gone also was my belief that my mind had somehow eradicated my malignancy.

My Fragile Eyesight

Of my 13 operations, six were related to my eyes. The first was in 1958 when I was in college and had difficulty reading. My eyes would not work together because of an ailment called exotropia. This problem had existed since I was a child, when the treatment of choice was eye exercises. For years, I would draw my index finger up to my nose, then reverse the direction, and repeat the process, trying to strengthen the eye muscles and see one finger rather than two. I hated these exercises, didn’t realize the consequences of double vision, and preferred to be out with my friends. I grew increasingly frustrated because I never got better at it.

From elementary school through most of college, I struggled with reading. As a sophomore in college, I had the reading ability of a 10 ^th grader. As described in Chapter 4, I was at risk of flunking out of college during my junior year and left school to join the Marines. When I returned, six months later, I was doing no better in school and had that Exotropia operation, which helped considerably. However, the condition redeveloped 60 years later, troubling because I knew from my past how frustrating and debilitating a failure to read effectively can be. Also, I was becoming increasingly interested in my writing and finding it difficult to stay focused on my computer screen. In 2018, I tried to schedule another exotropia operation, but it had to be shelved for over a month because of a problematic electrocardiogram.

When I went to my primary care physician for my pre-op evaluation, the electrocardiogram looked abnormal. I was referred to a cardiologist for further evaluation. She asked me if I had any difficulty walking. “When I walk up hills or steps, I find myself panting,” I admitted. She administered a stress test, but was unable to account for my panting so she referred me to a pulmonologist.

He performed a pulmonary function test and said, “Your breathing is perfect.”

“That’s good,” I replied, relieved, “but what about the panting?”

“You’re fat,” he declared and walked out of the examining room. I laughed at his blunt, outlandish remark, and my primary care physician also laughed and proclaimed me ready for surgery. I had the repeat exotropia operation, and my eyes worked together fine, at least for a while.

One day, in 2012, between the two exotropia operations, everything in my field of vision turned to a pale shade of green. That was, of course, concerning, but it was also funny imagining Kermit the Frog singing, "It's not easy seeing green." I skipped a meeting and, without calling first, went to see my very green ophthalmologist. He immediately sent me to a well-regarded retina specialist who, after taking some photographs, said I had a hole in the macula of my left eye, and I would need an operation known as a vitrectomy as soon as possible. The operation consisted of repairing the hole in the macula and then putting a bubble into my eye, which was intended to press against the wound like a bandage. However, the macula is located at the back of the eye, and the bubble would float up rather than back. Consequently, I had to keep my head down for seven days so that the bubble would reach the repaired hole and remain affixed to it. That was a real pain in the neck. The operation and the bubble did their job. A week later, photographs of my left eye showed that the hole had been repaired.

Unfortunately, three years after the operation, my macular hole reopened, an extremely rare occurrence. I had to go through another operation and another seven days of the head-down ordeal.

I won’t go into the rest of my ocular ailments or my other eye operations but will turn now to an unfortunate accident in January 2023 that could have ended everything.

The Fall

I fell down a flight of 16 steps inside our house. Linda later explained what had happened because I could not remember anything. She had been sitting in the living room, heard me fall, rushed over, and saw me at the bottom of the stairway, gasping for breath with blood flowing from my head. She called her brother, Larry Friedrich, to help if I needed to be moved, but they decided to call an ambulance to have me transported to the emergency unit at Columbia Memorial Health, a medical facility in Hudson, New York.

Linda stayed with me during my two-night stay at Columbia Memorial, sleeping fitfully in a chair in my room. The fact that I couldn’t remember anything about the fall or ambulance ride distressed me. I was 85 years old and thought that memory loss and an inability to focus could be signs of dementia. At eighty-five, my memory felt less like a convenience and more like a privilege, one I no longer assumed would always be there.

Examinations the next day determined that I had a concussion, a broken collarbone, a slight vertebral fracture, and some blood in my skull. The doctor said I needed to be examined by a neurosurgeon, but there were none available at that facility. I was sent by ambulance to the emergency unit of an affiliated hospital, the Albany Medical Center, which turned out to be chaotic and frustrating,

Linda did not go with me in the ambulance but drove to the Albany home of her brother, Dan and Lynne Friedrich, her brother and sister-in-law. They drove her to the hospital. When Linda found me in a small room and said I was lucky to be in there because the waiting room seemed dangerous. A staff member standing with me said that a preliminary examination indicated that I would not be admitted, so Linda asked Dan and Lynne to drive her back to their house so she could get our car. They had trouble getting into the parking lot because the hospital was suddenly in lockdown, presumably because someone was inside with a weapon.

Linda received a call from one of the interns, who said that I was ready to be discharged and would be placed in the hallway to wait for her. Disturbed by the specter of her 85-year-old, incapacitated husband lying helplessly on a gurney in an unprotected hallway, she insisted they keep me where I was, adding that she was only ten minutes away.

Linda helped me dress and spoke with a staff member, who said we should schedule a visit with an orthopedist. She got me into a wheelchair, wheeled me to our car, and drove the one-hour trip to our home, which we entered at about 2:00 AM on Saturday, January 21, the most anxiety-filled birthday of Linda’s life.

Linda said she felt lonely for the next few weeks because I was so uncommunicative. After some failed attempts, she managed to get me an appointment at the Capital District Bone and Joint Center in Albany. At that facility, the doctor said my collarbone was permanently deformed, but I was in no danger because of it. He said I could live relatively comfortably with the deformity, but, chuckling, said I should give up any hope of being a neck model.  Linda told him we needed to do something about my neck because my head had become stiffly arched toward my chest. The doctor arranged an appointment with one of his colleagues, a spine specialist.

She said I needed current MRI and CT scans, which were easy to request but exceedingly difficult to obtain. Nevertheless, after a few weeks, the spine doctor received the requested radiological materials and let me know that the vertebral fracture had healed, but she wanted me to see a physical therapist to treat what she termed cervical kyphosis, an exaggerated curve of the neck. Physical therapy helped, and they gave me three illustrated pages of exercises to help me get my head straight. I’ve been doing those exercises every morning, often thinking how glad I am that the fall didn’t kill me.

Death had been frequently on my mind, and Linda and I would occasionally observe the largely Hispanic holiday, Dia de los Muertos, or Day of the Dead, which originated in Mexico.. During that observance, people gather to pay respects and remember friends and family members who have died. I’ll never forget a very dramatic observance of that holiday at our house in Sunset Park, Brooklyn, which at the time was over 40% Hispanic, many of whom were Mexican Americans. During late October and early November, local bakeries were stocked with pan de Muerto, or bread of the dead, and cakes, cookies, and rolls similarly decorated with skeletal skulls.

Although neither of us is of Mexican heritage, we often used the Day of the Dead celebration as a model for our own remembrances. We decorated part of our 3-story Brooklyn brownstone townhouse with vases and garlands of marigolds from our garden and enjoyed the Day of the Dead bread and pastries. In 2010, we decided to light 50 candles in memory of 50 relatives who had died, a list easy to produce, since I was the family genealogist.

In the hallway on the third floor of our Brooklyn brownstone, we had a large rectangular marble-topped table, large enough to hold all 50 clear glass votive candles. Each candle was designed to burn for 10 hours. As each was lit, I recited one of the names off the list, and we briefly described our relationships with each relative. This process took about an hour.

When the ceremony ended, we went down to the ground floor but checked on our conflagration from time to time to reassure ourselves that our home was not in danger of burning down. The last time we went up, about two hours after we lit the candles, we could hardly breathe; 50 candles can consume a lot of oxygen.    All the windows and doors in the house had been closed because of the near-freezing temperature on that November day. We opened them slightly and blew out all the candles. This eliminated the specter of the whole house becoming as asphyxiating as the third floor had become, conceivably suffocating us as we slept, prematurely drawing us into the ranks of those we were honoring.

Standing among those flickering candles helped me think about all my afflictions. My knees had given out, my eyes had gotten worse, my hearing had deteriorated, and my memory had faded and continues to fade. Those afflictions and others tried to get in the way of my family life, my creative life, my spiritual life, my education, my career, my activism, and my travels, but eyeglasses, hearing aids, knee replacements, exercise, good food, and good medical care have helped me get through what all aging bodies do as they live long lives.