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Covid-19: 20,000 Dead, 40,000 more to Die

Posted in Health - aging, mostly by EloiSVM42 on April 11, 2020

I’m having some trouble getting my head around these Covid-19 numbers in juxtaposition with the pronouncements coming out of the White House.

In round numbers, in mid-April, we have about half a million diagnosed cases of Covid-19, with about 20,000 deaths due to the virus. This is a lethality rate of about 0.04%, which is much higher than typical viruses, but is also a moving number, which could decrease with more data.

60,000 total deaths are now the forecast, which means we may expect another 40,000 deaths. That is way down from the early models forecasting from 100,000 to 240,000 deaths, which is a really good thing (we learn as we go, right?), but still a whole lot of deaths. And that 60,000 figure, I understand, assumes complete social distancing and self-isolation (“if we do everything right”), which is not yet the case.

Trump says he wants to “open up” our economy about May 1. Hmmm. So, if the models are right, or close to right, and Trump thinks this thing should be over by May Day, that means we should expect another 40,000 deaths in the next 15 days, or about 2,667 per day.  Does anyone seriously expect the economy to “open up” in those circumstances?

Obviously, these numbers are ad absurdum. That many deaths are not going to occur in the next two weeks. In fact, some experts think the death rate may have peaked on Friday, when it hit 2,000. So, logically, these 40,000 projected deaths are going to stretch beyond May 1, possibly way beyond.

But channeling Trump’s optimism, let’s extend the timeframe to “open up” the economy to Memorial Day, May 31. 40,000 deaths over 45 days is still 889 deaths per day. I’m not buying it that people are going to be ready to go back to work when we’re still losing about a thousand lives a day to the virus.

These are not editorial comments; these are just the numbers and dates being presented officially. But it is plain as the bodies piling up in the morgues that the situation is a lot more nuanced than what is being advanced.

Sadly, Trump is not a nuanced kind of guy. He is a clueless kind of guy and not interested in becoming less so. So, interspersed with cautious comments from experts (cautious because caution is warranted and because if they speak too candidly, they know they will be fired), is a mash-up of happy talk and crazy talk.

The saddest thing is that Trump is too stupid to realize that if he would take/had taken forceful action to increase testing and mandate massive manufacturing of ventilators and other medical equipment, the timeframe would be shorter and the deaths fewer.

P.S. I’ve given up on trying to calculate lives lost unnecessarily by state, due to inaction or willful stupidity. The news that we let 40,000 people into the country directly from China after the date Trump said he had banned such entries, renders all the calculations mere guesswork and not worth the effort.

October 1, 2013 – Welcome Obamacare!

Posted in Health - aging, mostly by EloiSVM42 on October 1, 2013

I love Medicare. It has worked for me. I hate my wife’s personal health insurance. It has been highway robbery. We have been waiting impatiently for October 1, so we can start looking for better personal health insurance for her.

My entire health insurance bill totals about $250 per month. With the exception of drug co-pays, and the “donut hole,” this package covers everything. I have never received a bill for any doctor visit or other medical expense since I became eligible for Medicare. It pays 80% of my costs. My AARP supplemental coverage pays the other 20%. That’s it.

My wife’s personal health insurance costs more than $1,000 a month, and it covers very little. Her deductible is huge. She gets billed for almost everything. We consider her insurance as catastrophic coverage only, and I have little doubt that if we should have a medical catastrophe, the insurance company would fight us tooth and nail to avoid paying for it. We look forward to firing our current provider soon. We fully expect to get better coverage at a lower price.

Mind you, not everything is perfect. I expect Obamacare will be much like Social Security and Medicare, both of which began modestly and with implementation glitches, then expanded and improved.

Nor does my coverage arrangement make me completely happy. I pay AARP more than twice as much for AARP’s 20% of my coverage as I pay Medicare for the first 80%? Why is that? Why do I have Medicare and a supplement at all? Why can’t Medicare just cover 100% of the costs and eliminate the more expensive and less efficient insurance companies, who spend money on advertising and lobbyists? (Hmm. I think I just answered my own question.)

I have been in the prescription drug “donut hole” four out of the last five years, for reasons over which I have no control. My prescription drug costs skyrocket when I reach it, for the very same drugs. (Example: a drug I take costs $114 until I reach the “donut hole.” Thereafter it costs $550!) Why can’t we just get rid of the “donut hole? Oh, wait. Obamacare will eliminate the “donut hole.” Outstanding!

Beyond today, I look forward to when Medicare will absorb Obamacare and we will all be under one single payer system that will work better, cost less, do away with health insurance companies and put a foot on the neck of Big Pharma. This need has seemed obvious to me since college.

I know, I know. All this is an entitlement, but it is subsidized. Here are my final questions: Why wouldn’t we want our government to spend more of our taxes on our health and less on some other things? Why wouldn’t we want a plan that helps people prevent medical problems instead of confronting them in a crisis in the emergency room? Why shouldn’t we be willing to pay a little for these entitlements, if necessary? I would. Finally, why would we want to continue with the most expensive health insurance among the developed nations with outcomes only somewhere in the middle of the pack?

Dick Cheney’s Heart Transplant

Posted in Health - aging, mostly by EloiSVM42 on March 27, 2012

How did Dick Cheney qualify for a heart transplant. He never used the one he had.

Sudden Thought: Chik-Fil-A is Right!

Posted in Health - aging, mostly by EloiSVM42 on November 1, 2011

It is not politically correct to say it, but the only way this planet is going to survive in the medium-term is with population control.

Birth control, smaller family trends, and more rational medical decisions are fine, but at present they are just trimming around the edges. At some point we are going to have to bite the bullet, make the tough decisions, stop speaking in clichés and begin planned population elimination.

I’m speaking now, of course, about cows. Beef cattle, and much of our dairy herds are going to have to go, and we are going to have to eschew our love of steak and hamburgers.

While people around the world are going hungry, almost a third of our grain production is going into raising cattle. This is conspicuous consumption that outranks even our own.

Also, cattle are major polluters. One of the most polluted areas in the country is in the San Joaquin Valley of California. It is a mostly rural  area – in fact it is one of the areas of greatest agriculture production in the country, an unlikely place to expect so much pollution, which we generally associate with urban smokestacks and automobiles. The reason the San  Joaquin is so polluted? Methane gas, or as elementary school students call it, “Cow farts.”

Yes, cows produce so much gas from their grain munching that it’s surprising the entire valley doesn’t combust spontaneously. Drive Interstate 5 either way between L. A. and San  Francisco, and for much of the drive it smells like one big cattle feedlot…because it is.

I write with a little humor about this because, well, to many people cow farts are funny. But I’m also making a serious prediction. Cattle will soon be an endangered species, soon thereafter will be virtually extinct. It’s them or us.

Cancer Diary – Fifth Entry

Posted in Health - aging, mostly by EloiSVM42 on August 5, 2011

My surgery was early Monday morning, December 7. Cynthia and I drove to Phoenix
on Sunday and stayed overnight at the hotel on the Mayo campus to be fresh and
ready the next morning.

Before we left Prescott, I filled the bird feeders. As I was doing this, a Bewick’s wren landed on the ground within three feet of me and began to peck at seeds. He wandered up to my
foot, and then onto my shoe! Often in my life, interesting birds have appeared unexpectedly
and brightened my day.

As for the surgery, there’s not a lot I can tell. I slept through it. We did learn that it was “major.” I was on the operating table for six and a half hours, longer than expected. I awoke heavily drugged, very weak and with numerous tubes sticking into and out from me in various places.

Over the next three days, the tubes were removed sequentially, save one – a feeding tube, stitched into my nose, running down to my stomach and hanging out from my nose about 18 inches. I fed exclusively on liquid nutrition through this tube for two weeks.

I was discharged from the hospital, though I was still drugged. So we immediately checked back into the hotel for a week, which Mayo applauded, as they could monitor me. This was a good decision. The drugs wore off, though not the weakness. We got to practice using the feeding tube unsupervised, but with help nearby if we needed it. And, Cynthia met with the
doctors and they changed two of my medications. At the end of the week Mayo pronounced me doing well and ready to return toPrescott.

It was good to be home, but I was still very weak and we were still using the feeding tube. In another week, we returned to Mayo for a check-up. The surgeon said I was doing very well and he was ready to remove the feeding tube. He snipped the suture holding the tube in my nose and pulled. I was sure I would gag and/or vomit when the tube came up, but it came up quickly and easily. The surgeon sent us back home for another month.

The tube was an ordeal. How much of an ordeal we didn’t realize until it was out. When we got out into the parking lot, both of us started crying spontaneously with relief. We were like the French when the Allies liberated Paris.

Social Security cola should be raised, not lowered

Posted in Health - aging, mostly by EloiSVM42 on July 21, 2011

It is intuitively logical and just to build a cost of living adjustment (cola) into benefit programs. Without one, benefits will shrink cruelly over time, due to inflation, until the “benefit” becomes worthless, if the beneficiary is unfortunate enough to live that long.

There are compelling arguments for and against how the government calculates colas today, and also good arguments for and against some proposed alternatives, e.g., why would we eliminate gasoline and food prices from the calculation just because they are “volatile?” They comprise a large portion of what people actually buy.

Whatever the arguments pro and con in general, the current calculation method is illogical and unfair for calculating colas for Social Security benefits, about which colas get the most attention. This is because the cost patterns of Social Security recipients differ significantly from the average consumer. (Full disclosure: I am a Social Security recipient.)

Currently, we are being told the cola calculation needs to be re-adjusted to save money, and that this is OK because the formula overstates Social Security recipients’ cost of living. This is utter nonsense, concocted to rationalize a money-saving, but unjustified reduction in Social Security benefits. In fact, the cola should be increased, not decreased. Here’s why:

By definition, the vast majority of Social Security beneficiaries are older, at least 62. By this stage in our lives, our costs of living skew much more heavily toward healthcare than when we are younger. I’ll mention some personal experience below, but does anyone deny that healthcare costs are growing must faster than living costs in general?

In 2008, the latest year for which there are complete data, healthcare costs rose 4.4%. This is a slower rise than recent years (healthcare costs rose almost 18% a year between 1990 and 2008), but still well ahead of inflation, the basis for cola adjustments.

My own experience goes something like this: through my 30’s, I went to the doctor, and an eye doctor about once a year for a check-up. In my 40’s I added an orthopedist for the occasional back strain. In my 50’s I added a neurologist for proctoscopic exams, and in my 60’s I added a cardiologist.

In late 2009, I was diagnosed with a serious, life threatening disease that required two surgeries and radiation and chemotherapy to treat, with the result I was in a doctors office or hospital nearly every day for the first four months of 2010.

Finally, my drugs are covered by the Medicare Rx plan, and I have been in the “donut hole,” paying full price for my drugs for most of the last four years. In 2010 I was in it after January.

Bottom line: I’ve paid more in medical bills since I turned 65 three years ago than I paid my entire life previously.

My wife is too young for Medicare, so she has personal health insurance, whose premiums, already expensive, have risen 44% in two years. And this insurance pays for almost nothing. The deductible is astronomical. A recent trip to the ER cost us thousands of dollars. We keep the insurance for catastrophic illness only, and should we have one, I am sure there will be a huge fight with the insurance company, bless ‘em.

This is not a critique of our healthcare industry; I’ll address that another time, and there is much to critique. This is only to observe that Social Security beneficiaries’ costs are heavily skewed to healthcare, and that healthcare costs are rising much faster than inflation as a whole. A fairer cola calculation for Social Security payments would take this into account.

 

 

 

Cancer Diary – Fourth Entry

Posted in Health - aging, mostly by EloiSVM42 on July 10, 2011

Friday, November 20, was our pre-operation preparation day at the Mayo Clinic. Cynthia and I drove down to Phoenix that morning for a series of meetings that began at 9:45 am and ended at 3:30 pm.

It should be recorded that we began my own preparation by meeting with my cardiologist the day before. I had recently had an echocardiogram, and the first order of business was to review the results, which were fine. The second was to discuss the surgery.

In response to the news about the surgery the cardiologist changed one of my medications. He also raised a concern. Mayo Clinic wanted me to stop taking my daily aspirin tablet two weeks before the surgery. The cardiologist preferred one of a couple of alternatives. I told him I would raise his concern when in Phoenix. He also scheduled a stress test for me on Tuesday, November 24 for another check step before surgery.

When we arrived at the Mayo Clinic we were given a written itinerary for the day, listing each meeting, at what time and where. Mayo Clinic is organized and professional, more so than any medical facility I have ever visited.

The first appointment – check-in – lasted only about 15 minutes. They just confirmed we were there, and, of course, as with all medical facilities, that we had insurance coverage. First things first. They had me state my name and date of birth, to be sure they had the right patient.

At 10:30 am, a nurse escorted us to our next appointment – the pre-operative medical exam. On the way the nurse asked me to spell my name and state my date of birth. When we arrived for our appointment, we were greeted by another nurse whose job it was to prepare me for the examining physician. The nurse began by asking me to spell my name and state my date of birth. She asked a lot of screening questions about my medical history and then told us what to expect from the examining physician.

The examining doc came in and asked me to spell my name and state my date of birth. He examined all my records and we discussed them. I gave him a copy of the report from my recent echocardiogram, and he was delighted because the results were good, and it meant that he wouldn’t have to give me an EKG there. Likewise, he was very pleased to learn that I am going to have a stress test on the 24th, and gave me a fax number for sending him the results.

It was at this point that the difference of opinion about aspirin between my Mayo surgeon and my cardiologist came up. This doc laid out both sides of the debate concisely, and relieved my mind by saying he was sure a compromise could be worked out. He even listed a couple of compromise possibilities. We left it that the two docs would talk and work out a decision the following Monday or Tuesday, and let us know what to do. Finally, he gave me a list of which of my meds I should take the morning before the surgery and we were done.

There was time before our next appointment, so we had lunch at the cafeteria, which is available for staff, visitors and even ambulatory patients. I had fasted since the night before, and as it was now almost Noon, my first need was a cup of Starbucks coffee. So was my second. The food was so good that when we were finished at the end of the day, Cynthia actually wanted to have dinner there. We didn’t.

Our next appointment was at 12:30 pm for a Radiology Exam. The nurse who escorted us to the technician asked me to spell my name and state my date of birth. I gave a date one year off my birth year to see if she was paying attention. She was. The appointment was quick and easy, just a few chest X-rays. We finished in half an hour.

Our last appointment was at 2 pm with the Radiation Oncology department. Like Ebenezer Scrooge, I dreaded this last appointment the most. The preparing nurse began by asking me to spell my name and state my date of birth. This I did, and then I asked her a question. “Please state the name of this hospital.” I guess you had to be there.

Our dread was heightened at bit when the nurse asked a lot of questions we had answered previously. We inferred this was an autonomous department and that these people might try to sell us on a therapy different than what we had already agreed to.

Our worries were assuaged when the oncologist came in. He was very impressive and professional. After asking me to spell my name and state my date of birth he did a thorough on-site inspection, via the tube down my throat. (Ever since I heard about this procedure it seemed dreadful to me, but now it has happened to me so often I hardly notice it.) Then he told us several encouraging things.

First, he said he had discussed our case with the surgeon, and after examining me he agreed completely that surgery is indicated in my case. He noted that the surgeon always has his patients speak with the radiation oncologist whatever his, the surgeon’s, recommendation is, to be sure the patient has all the facts and options.

The oncologist said my tumor is a T1 – the first person to use this term with us, though we had read it. This means the tumor is in the category of smallest size, and presumably in a very early stage. He estimated the chance that I will need follow-up radiation therapy at 30%, much lower than we had expected.

The oncologist told us what to expect from radiation therapy. I’ll skip the details of this unless and until it should prove necessary. Suffice it to say that Cynthia and I have been talking about spending several weeks in a warmer place this winter, such as on the desert floor in Phoenix or Tucson, and if I need radiation we’ll have our wish. In the future, we need to wish more specifically.

The oncologist ended the interview by saying, “Of course, sometimes we get surprises.” Nevertheless, Cynthia and I left the Mayo Clinic this time feeling both more informed and more optimistic. We chatted and smiled all the way home.

It’s conventional wisdom, except among plastic surgery patients, to avoid all surgery unless it is absolutely necessary. I interpret this to mean eschew surgery until the discomfort gets to the point I am ready to do the surgery myself with a rusty tin can lid, with our without anesthesia. My throat gets a little sorer each day, and I project that by the surgery date – December 7 – I’ll be in that mood. Unless something unexpected occurs, I probably won’t make another diary entry until after the surgery. We’re going to spend next week enjoying a visit from one of my daughters, who is coming for Thanksgiving.

Cancer Diary – Third Entry

Posted in Health - aging, mostly by EloiSVM42 on May 5, 2011

Since we’ve returned from the Mayo Clinic, we’ve been reading the research paper that the Mayo doc gave us about the procedure I’ll be undergoing. Though the survival rate is very encouraging, some of the other statistics are sobering.

The survival rate (for at least five years) is about 90% or even higher in many circumstances. That’s the good news. Here’s some other stuff: 

  • Neck dissections are performed in 83% of cases. This will definitely happen to me. They plan to remove the lymph glands in my throat to see what and how much may have gotten into there. From this, they will determine whether I will need “adjuvant radiation therapy.” So, in addition to having a sore throat on the inside, I’m going to have a sore throat on the outside.

 

  • Two thirds (66%) of patients were offered post-operative radiation therapy. They won’t know until they’ve looked at my lymph glands whether this is warranted in my case, but the statistics indicate I may well be a candidate. We’re told this therapy can be rough. Some patients have chronic dry throats thereafter, and some even lose their sense of taste.

 

  • 37% of patients required a temporary tracheotomy (I’m not sure what this means. You either have a tracheotomy or you don’t. It’s like being pregnant or not. I suppose they mean that the patient won’t be breathing through a hole in the throat for the rest of his life. On the other hand, women aren’t pregnant for the rest of their lives either. It only seems that way. Might as well just call it tracheotomy.) So, the odds are one in three that, in addition to a sore throat and a sore neck, I’ll have a hole in my throat.

 

  • 75% of the patients received a feeding tube, inserted through the nose. They’ve already told us that I will have this pleasure. This can last from one to three weeks, though they think, due to the relatively small size of my cancer, that I’ll likely only be fed this way for only a week.  

All-in-all, while the outcome looks favorable, I figure to be in for a rough month or so.

Also since we returned, Cynthia checked out a half dozen books from the library on health and healing, and has been reading to me inspirational messages from them. These include books published by the Mayo Clinic and others written by Deepak Chopra, M.D.

My throat is getting progressively sorer. It’s not that it is so painful, but it is a constant reminder of what’s in my throat, and it’s bad enough to affect my sleep. Cynthia called Mayo Clinic and the young assistant doc called right back, which was much appreciated. He called in a prescription for a drug that is both a pain reliever and a cough suppressant. So, I’m sleeping a little better, but Cynthia is so stressed she hardly sleeps at all. She’s more worried about me than am I, which is very sweet.

The doc also said it is important that I eat to keep my weight up. I infer from this that they expect me to lose a lot of weight while I’m being fed through the tube.

We return to the Mayo Clinic on Friday, November 20 for a pre-surgery “testing” day. There’s nothing much more to do until then. I’ll write another installment after the tests.

Cancer Diary – Second Entry

Posted in Health - aging, mostly by EloiSVM42 on April 3, 2011

Cynthia and I drove to Phoenix the day before our appointment at the Mayo Clinic on Tuesday, November 10. We spent the night at a Residence Inn that is on the Mayo Clinic campus.  The campus is on the eastern outskirts (at least for now) of Phoenix, and there is nothing within a mile of it in any direction, so we infer that most of this hotel’s clientele probably comprises patients coming from out of town and the families of those staying at the hospital. 

We had two appointments at Mayo, the first at 9 am to get registered and the second at 10 am with the doctor. We arrived a little before 9 am and they began registering me immediately. They started asking the same questions that are on forms they sent us to fill out in advance. They seemed surprised and pleased when I told them I brought the forms and told us that not many people do. I also brought a CD of records and images from tests taken previously. They took the forms, and loaded the CD onto the doctor’s computer.

I remember scoffing at the notion that a lot of money can be saved with a system of centralized medical records, but the savings potential must be huge. I’ve filled out so many forms with the same questions that we might save a zillion dollars on me alone.

We finished registration and were sent to the waiting room. It occurs to me that what we may be waiting for is to learn how long I have to live and how uncomfortable my remaining time will be.

As we were early, I had time to consider the other waiters. Most, but not all, were my age or older. The women on average were older than the men. A few seemed fitter than I, but most did not. A couple of people were wearing masks. This could have been to avoid germs due to impaired immune systems. But it could also have been cosmetic, to hide the results of disease and/or surgery. Fortunately, we did not learn which.

We were now on typical medical office schedule, which means running very far behind. We were forewarned about this, because my doctor “likes to spend a lot of time with his patients.” Fine by me. Nearer the appointment, the quieter my mood. Inner tears and apprehension.

When we were shown into our consultation room we were joined quickly by a young doctor who is an assistant to our main doc. He was pleasant and obviously competent. He took some more information, did an inspection with a tube down my throat, and told us what to expect from our doc.

Our doc arrived. We had heard and read about him. He is a leader in his field, as are, it seems, most of the docs at the Mayo Clinic. This doc deserves his reputation. He is serious and thorough. He exudes gravitas. It seems almost impertinent to refer to him as a “doc.”

The doc made his own inspection, and told us more about this kind of cancer. Fortunately, a very small percentage of them metastasize below the neck. This doesn’t mean they aren’t dangerous, but the success rate in dealing with them is very high today.

The doc laid out my treatment options: surgery; surgery plus radiation therapy, possibly; radiation and chemo therapy without surgery. The descriptions were thorough, candid, and therefore unsettling. After hearing the options and asking questions, we concluded the best way for us to proceed is with surgery. The doc said this decision should be made by the patient, but he agreed, that, yes, in my case starting with surgery is a “no brainer.” The doc gave us a copy of a major research paper, of which he was one of the authors, which is reassuring about the procedure and the success rate.

When I describe the surgery it may be surprising that it is the best of the options. The cancer will be removed by “Transoral Laser Microsurgery.” Due to swelling, I may need a temporary tracheotomy. Then, the lymph nodes below my mandibles will be removed via conventional surgery, to see if and how far the cancer might have traveled. Finally, a tube will be inserted through my nose into my stomach, by which I will be fed for about a week.

Depending upon the condition of the lymph nodes, I will be finished, or I may need radiation therapy.

I will be in the hospital for about three days. Cynthia will be able to stay in the room with me. Thereafter, I will be free to return home, coming back a week after the surgery date for a check-up. Cynthia and I decided we will just check into the hotel on campus and stay there until the check-up rather than return home.

The doc reminded us that the throat is an extremely important part of our anatomy. We breathe through it. We eat through it. It is very sensitive (a fact of which I am all too aware). I will be uncomfortable for awhile, and the adjuvant radiation therapy is something we should hope to avoid.

When the doctors left I pulled Cynthia onto my lap and we began kissing, which seemed like the thing to do at the time. The scheduling nurse walked in and caught us. Actually, she was very pleased. She said she seldom sees kissing there, and it is in fact very good therapy and important in keeping a positive attitude toward the experience.

The surgery is scheduled for December 7, about four months from my first doctor’s appointment. They said they would move it up if they can, but it is unlikely, and in any event waiting won’t affect the outcome, just prolong our anxiety and my sore throat a little longer. Also, we will come in for a check-up about two weeks in advance of the surgery, and thereafter I will have to stop taking some meds I am now on.

After the appointment, we went to the Desert Botanical Garden, where I hoped to add a bird to my life list – the Verdin (Auriparus flaviceps). It is common in the desert brush, but I had never seen one. I found the bird after a couple of hours searching. As we were leaving, we realized that we will have to return, because it is a beautiful place, but between the stress of the medical appointments and my searching for the Verdin, we had hardly noticed and appreciated it.

We planned to try a Mexican restaurant we read about in Arizona Highways, but we decided to skip it this trip and head home. It was a good thing, too, because on the way home the car died, and we had to be towed home by AAA, so we got in later than planned. It was only a dead battery, fortunately.

It was a hell of an interesting day.

Cancer Diary – First Entry

Posted in Health - aging, mostly by EloiSVM42 on March 31, 2011

On Sunday, March 27, we threw an open house to celebrate the anniversary of my first year of  survival from a bout of serious cancer (The actual anniversary date, when I returned home from the Mayo Clinic, is March 23).

Discovery of the cancer actually occurred about six months before the treatments began.  I chronicled the entire experience in a series of nine journal entries, which I am going to post sequentially over the next two months.

Most of these entries were written after the fact, because as I was going through the treatments I was too addled to think, and far too enervated to write. In fact, at the nadir, I was too weak to lift a telephone, and could barely lift a toothbrush. The first entry begins below:

About a year a half ago, I started noticing troubles with my throat, most particularly, trouble swallowing. Everything seemed to go down the wrong pipe. Also, I seemed to be coughing frequently, particularly at night. And finally, I developed a mild sore throat that felt like a cold that had gotten into my left Eustachian tube. 

I spoke with my doctor about these symptoms (August 12), and he sent me to the best ENT specialists in town. The ENT doc performed an on-site inspection of my throat by sticking that tube with a light and a camera down there (August 14), then put me through a number of tests at a lab, including x-raying my throat as I swallowed barium (August 19).

The ENT doc said he found nothing in my throat, and that my swallowing difficulty is no more than is to be expected for someone my age. He prescribed something to fight acid reflux, an affliction also typical for my age, and which may be causing some throat irritation.

The diagnosis was reassuring, and the medication seemed to help my acid reflux. But the sore throat continued, and a couple of weeks later I called for another appointment and told him things just didn’t feel right.

He gave me another on-site inspection with the tube (October 7). “I see something there this time I didn’t see before,” he said and took a biopsy of a nodule on the base of my tongue (October 12). The biopsy required putting me out mildly so he could work in my throat without triggering a gag reflex.

The biopsy happened the Monday before I left for an eight day trip to Texas and Kansas on Wednesday. I asked the ENT doc if I should cancel the trip, but he said whatever it was could wait until I returned. He said he would call me with the biopsy results in Texas on Friday.

But the doctor called back the very next day (October 13). Apparently he sensed a problem and asked that the biopsy results be expedited. I was away and Cynthia took the call. “It’s a cancer,” he said. “But it’s treatable; it’s curable; we’ll save his life.”

When I returned home, Cynthia told me about the call. When she began, she was clearly upset, pacing and starting to cry. In a confirmation of the theory that when we don’t have the facts we assume the worst, I thought she was about to tell me she was leaving me or something. I was actually relieved when Cynthia told me I had cancer.

Cynthia had made a follow-up appointment with the ENT specialist, and, upon his referral, we also made an appointment with a specialist at the Mayo Clinic in Scottsdale, Arizona. The soonest he could see me was November 10, but the ENT doc said this was no problem. The cancer is not a fast moving one. For the same reason, he said I should take my trip to Texas, which I did.

I told a couple of my close friends about the diagnosis, one of whom gave me an article to read about throat cancer, which was considerably less rosy than my doc’s prognosis. I resolved to stop reading about it and not to think about it until I saw the Mayo Clinic specialist on November 10.

There’s a fanciful formula for turning lead into gold. You melt the lead without thinking of the word “hippopotamus.” It’s never failed because it can’t be done. Not to think about a cancer diagnosis, if you have one, can’t be done either.

The first thing I thought about is how it might affect my immediate plans. If I have an operation, which seems likely, will I be unable to talk for awhile?  If not, for how long? Would this affect my teaching schedule; my ability to eat; my ability to taste? How long will it take to rehabilitate?  Will I be up to the cruise we were planning next June?

Then I began to think how gruesome the treatments might be, and from there, of course, to about whether and when this might kill me.

This thought had a dramatic effect on my priorities. Most of the items on my personal “bucket list” dropped off. I stopped reading as much, and I put off the idea of learning Spanish, because there may not be much long term benefit to improving my mind. And I put off some scheduled dental work, because I don’t see the sense in spending money on something that could be incinerated shortly.

I thought of how much of our retirement savings I might spend on myself in “last things” activities, and how much to leave, considering that my life insurance policy will kick in. Macabre.

On my follow-up visit to the ENT doc (October 26) he gave me the official diagnosis – “Squamous cell carcinoma, moderately differentiated, ulcerated and tumor infiltration. No vascular penetration identified.”

This last phrase is apparently a good thing, meaning that the cancer had not gotten into my bloodstream to circulate elsewhere, though perhaps to the nearby lymph nodes in my neck.

Also during the follow-up, the words “possibly fatal, but unlikely” were spoken, which were completely ignored by Cynthia but not by me. My sense is that the ENT doc felt we dodged a bullet by my insisting to come in for a second look at my throat.

But that meeting heightened my sense that my clock is ticking. I was eager and anxious (two words often confused and misused) for my appointment at Mayo on the 10th. It would be almost three months to the day when my doc sent me to the ENT guy.   

I thought some about how the stress of this may be affecting my heart and blood pressure, something Cynthia seemed to be worrying about constantly. Our plans until the 10th, based on recommendations from the ENT doc and guidance from Cynthia, were to exercise, eat healthy meals and avoid the flu. 

Until then, my two fears were:

1        That I will undergo an operation and radiation and/or chemo therapy, and then learn that it was all unsuccessful, but has left me too enervated to be able to do anything much with my last days, and

2        That even with insurance, the expenses will be so great that they will wipe out our retirement savings, something I have promised myself I will not let happen to Cynthia. This would cause me to have to choose whether to abandon treatment to keep a nest egg – a whole new twist on the line, “Your money or your life.” As Jack Benny said when confronted with this threat by a robber, “I’m thinking. I’m thinking.”

Since there was little more to learn until the 10th, I stopped making diary entries until after the consultation. Cynthia and I drove down to Phoenix the night before, and planned a trip to the Desert Botanical Garden in Phoenix after the appointment.