Clearing the Air: No. 4

The notorious stage theory of Elisabeth Kübler-Ross, whereby one progresses from denial to rage through bargaining to depression and the eventual bliss of “acceptance,” hasn’t so far had much application in my case. In one way, I suppose, I have been “in denial” for some time, knowingly burning the candle at both ends and finding that it often gives a lovely light. But for precisely that reason, I can’t see myself smiting my brow with shock or hear myself whining about how it’s all so unfair: I have been taunting the Reaper into taking a free scythe in my direction and have now succumbed to something so predictable and banal that it bores even me. Rage would be beside the point for the same reason. — Christopher Hitchens, “Topic of Cancer,” Vanity Fair, August 2010

***

Christopher Hitchens has said, upon contemplating his own medical predicament in the above piece and in interviews, that having cancer was nothing like a “battle,” as most people politely frame the discussion when the grim news comes around. There is no battle, he said. “You feel as if you’re drowning in powerlessness,” he said, and elsewhere, “I’m not fighting or battling the cancer. It’s fighting me.”

As for myself, I wasn’t as far along into respiratory degeneration as I am now when the Reaper turned his wintry stare on Hitch six years ago — and in the process, cut down one of the preeminent thinkers of our time and one of the greatest writers of any time — but I think I knew, even then, what he was ultimately implying, even if he didn’t come right out and say it. Outside of extreme intervention — aggressive chemotherapy, bypass heart surgery and organ transplantation — human beings usually can’t come back from the brink when faced with certain forms of cancer, obstructed arteries or lung disease. And fortunate as we are to live in an era of research and discovery, without modern medicine and science, we, as a species, would be left exactly where we started: trembling before the stars and wondering, in our own baffled ignorance, what capricious god we must have angered to be stricken with all sorts of maladies — a weak heart, bad sight, a wobbly gait — to send us to our unceremonious graves. In many cases, then, cancer isn’t a battle so much as it is a civil war; a person’s own cells, metastasizing and turning against them in an unwinnable, merciless onslaught. It’s Pickett’s charge without the bayonets and the ensuing inevitability of surrender. That’s certainly what cancer is without medicine, and that’s sometimes what it is with chemotherapy, which Hitchens preferred to call “venom.” With cancer, then, there are a few winners, no shortage of brave fighters and unfortunately, a disproportionate number of losers.

The struggle

Hitchens, as do I, preferred the analogy of the struggle when thinking about chronic illness. Readers, or people who know me personally, will no doubt know by now that I draw a lot of inspiration from “The Myth of Sisyphus” essay by Albert Camus and the tale of a man who, after daring to trick one of the gods, was ordered to heave a rock up a mountain, only to have it roll back down to the bottom and to repeat the process endlessly. It is in this essay and in the imagery of Sisyphus’ seemingly “futile and hopeless labor” that we see one of the most profound illustrations of struggle and perseverance.

sisyphus_by_ahermin

Camus invites us to imagine the sweat and toil Sisyphus mustered to get the boulder up the mighty slope just one time and then, as with all other subsequent ascensions, he watched as the rock inevitably crept back down the mountain. At the summit, Sisyphus turns and prepares to meet his fate once again.

Camus calls this brief interlude — “that pause” — Sisyphus’ “hour of consciousness” constituting mankind’s singular point of triumph:

At each of those moments when he leaves the heights and gradually sinks toward the lairs of the gods, he is superior to his fate. He is stronger than his rock. … If this myth is tragic, that is because its hero is conscious. Where would his torture be, indeed, if at every step the hope of succeeding upheld him? The workman of today works everyday in his life at the same tasks, and his fate is no less absurd. But it is tragic only at the rare moments when it becomes conscious. Sisyphus, proletarian of the gods, powerless and rebellious, knows the whole extent of his wretched condition: it is what he thinks of during his descent. The lucidity that was to constitute his torture at the same time crowns his victory. There is no fate that can not be surmounted by scorn.

Sisyphus, then, becomes what Camus calls an “absurd hero,” who relishes in what it means to be alive, spurns death and defeat and goes about the only things that he now knows: self-preservation and his rock. Thus like Oedipus, Sisyphus and modern man must eventually conclude, “Despite so many ordeals, my advanced age and the nobility of my soul make me conclude that all is well”:

I leave Sisyphus at the foot of the mountain! One always finds one’s burden again. But Sisyphus teaches the higher fidelity that negates the gods and raises rocks. He too concludes that all is well. This universe henceforth without a master seems to him neither sterile nor futile. Each atom of that stone, each mineral flake of that night filled mountain, in itself forms a world. The struggle itself toward the heights is enough to fill a man’s heart. One must imagine Sisyphus happy.

Unlike Oedipus, Sisyphus is not a tragic figure, but a person who perseveres and finds purpose, and possibly even contentment, in circumstances that, on the surface, seem to offer little. He finds wonder in each atom of that rock; he marvels at life in the void of night. The lesson is poignant because it teaches us to appreciate life, to carve out a little corner of happiness and enjoyment for ourselves, regardless of the circumstances. Or, as Milton said, to “possess a Paradise within thee, happier farr.”

Indeed, in order to weather the inevitable battery of tragedies that could befall us at any given time, one must imagine what life would be like during a worst case scenario, and we should emotionally prepare ourselves for it because before I get to the end of this paragraph, someone, somewhere, is indeed approaching the precipice and lowering their eyes on the darkness. None of us are all that far away from the edge, from the worst of things, as we might like to imagine.

And so, realistic hopefulness is where you find me here amid the struggle — the creeping ascent, an upward gaze, a cloudbreak before the retreating fall and a turn toward the heights in the gathering dust.

Philosophical musings notwithstanding, the physical analogies I draw from Sisyphus should, by now, be obvious. The process of breathing with COPD is like walking up a steep hill all the time or holding your breath too long in the deep end of the pool. It’s a slow and inevitable march that will catch up with me sooner or later without a transplant. That’s not resignation; it’s just basic medicine, and so, realistic hopefulness is where you find me here amid the struggle — the creeping ascent, an upward gaze, a cloudbreak before the retreating fall and a turn toward the heights in the gathering dust.

The middle

I said in the last post that I would cover some of the other complications that have made getting on the list and on the operating table a tough sell. In addition to an irregular immune system, I also have what is known as achalasia, which, compared with these other health issues, is actually pretty common. It simply means that the esophagus does not carry food down the throat to the stomach as well as it should. As such, food sometimes gets lodged down the gullet, and in bad cases, patients have to regurgitate and just hope the passageway opens back up on its own. So far as I know, I have had this since I was a child, and I have had to eat slowly and at a measured pace ever since.

A person with this condition doesn’t have to swallow food whole in order for substances to get stuck. Some foods, like rice, pasta, chicken and steak, require lots of chewing, and even then, if you eat too fast, they will get stuck. Since I have lived with this for the better part of three decades, I usually don’t throw up anymore. I know what foods tend to get stuck and eat and drink accordingly.

It’s hard for me to describe what it feels like when food does get stuck. Most people will be familiar with the experience of drinking a cold swallow of water and feeling it go down their throats. If the esophagus is closed, even water doesn’t go down, so if you keep drinking or eating after the problem occurs, it feels like fluid and food is building up in the middle of your throat. If it doesn’t “clear” on its own, there’s nowhere for it go but up. Once enough food and liquid start to build up, patients tend to feel a lot of pressure until eventually, it just feels better to throw up than to continue to hold it down. In the past, I have been able to hold it long enough where it did clear on its own, but that’s a far from pleasant experience. The best of all options, of course, is to eat slowly and don’t get sick in the first place because once a person throws up the first time, it usually takes longer for the esophagus to go back to its normal state. In previous episodes, I have spent the better part of a day waiting for the damn thing to open back up. Pretty disgusting, huh?

Doctors have a few treatments for this, including muscle relaxers, a rather routine surgery called an esophageal dilation and a more complicated procedure known as a heller myotomy. I have had numerous dilations, and if I move forward with a lung transplant, at some point after the operation, doctors will want to perform a myotomy to mitigate the issue.

The complication, as it relates to the lung transplant, is that achalasia patients usually also have problems with acid reflux and aspiration, which means, because the esophageal muscles don’t function properly, materials from the stomach can come back up into the throat and damage the lungs. As I said earlier, doctors don’t seem to know for sure, but this could have been what contributed to some or all of the initial lung damage in the first place, and this is why Duke did not approve me for the lung transplant, although they knew beforehand that I had achalasia.

In any case, the sequence of steps will be to first get me through the lung transplant, look at performing the myotomy a few weeks into the recovery period and then the bone marrow transplant two or three months after the lung transplant. The kick in the nuts about the swallowing problem is that I will not be allowed to eat or drink anything for four to eight weeks after the lung transplant and will get nutrients through a feeding tube. I have assured doctors that I have the wherewithal to sustain this exercise in mental endurance. We will see if I actually do. Not eating is one thing; not drowning myself in coffee every day will be another one altogether.

***

I’m not sure yet what I will write about next, as I have been fairly restless the last several days. My parents and I have since left the Family House in the medical district of Pittsburgh and am currently living in an apartment in a place called Wexford. I sustained what hopefully will be a minor setback regarding insurance. While the lung transplant itself was covered, the bone marrow transplant has yet to be approved. The two procedures go together. Because of the aforementioned complications, I don’t qualify for new lungs without the bone marrow transplant. My case manager at the hospital was under the impression that the bone marrow procedure would be covered through a research grant, and it may well be, but at this preliminary juncture, the insurance has to be approved before we can move forward. As such, I was made inactive on the transplant list temporarily until funding is approved for the bone marrow transplant. I am hoping for a resolution this week.

[Artwork credit: “Sisyphus” by DeviantArt user ahermin.]

Clearing the Air: No. 3

The transplant chronicles of a journalist, bibliophile, epistemophiliac and homo sapien.

***

Lest it appear that my last post was nothing short of a whole-cloth evisceration of all private health insurance companies everywhere, I do have more information to share that may balance the scales a little. Obviously, I did get another evaluation and did get approved for a transplant, or else I would not be sitting here looking out over UPMC at this moment. But more on all that later.

But first, let me say a word about customer service. In dealing with my company’s insurance carrier, UMR, I was almost solely in communication with one person — the transplant case manager. As we all know, the robotically trained peons who answer the phone at any insurance company’s 800 number are, by and large, utterly useless. Case managers, then, are supposed to be more skillfully trained in being able to answer complicated questions, and my particular case was about as complicated as it gets. Even so, the failures were many.

corporate_lobby

Here is what I tried to explain for weeks and months during the previously referenced appeals process: I didn’t know that my insurance company even had a limit on the number of medical evaluations a potential transplant recipient could receive until I had already reached the mark. There is nothing special about a transplant evaluation. All it is, is a weeklong series of tests and meetings with doctors and consultants to ascertain whether a patient can be accepted into the program. As such, I was under the impression that these appointments would, for insurance purposes, be treated like all other appointments. But no. Transplant evaluations are categorized differently because they can get quite costly, usually totaling $50,000 or more. Thus, from an insurance company’s perspective, if a patient is unhealthy enough to “fail” two evaluations, she is unlikely to be approved on the third try, so companies usually set the cap at two. So, while I wasn’t aware of the limit — technically, again from the insurance’s perspective, it was my fault for failing to find the pertinent language, plainly spelled out in black and white, on page 80-something of the voluminous policy — perhaps I could have been afforded a little slack in being solely concerned about getting access to health care rather than having an atomic-level knowledge of every nuanced detail in the document.

Although my insurance case manager knew that I was trying to get approved for a transplant, no one bothered to mention before I set up the second evaluation at Duke that the University of Pittsburgh Medical Center could become an in-network facility in a matter of weeks (see previous post) or that it was even being considered. Surely, this process doesn’t take place overnight. At the time, I was more confident than not that Duke would accept my case, so it’s not like I went there kicking and screaming, but had I known that UPMC was a possibility in the near future or if someone had told me about other in-network options like Cleveland Clinic or John Hopkins — both of which treat high-risk cases like myself — perhaps I would have waited. 1 As I have said, only after I used up the second evaluation did I learn that UPMC had become an in-network facility, which is what I tried to explain multiple times to my case manager who should have had my best interests at heart. I saw little evidence of it.

With the above information, I requested a narrow exemption given the particulars of my case, the severity of my condition and the requisite expediency. During the earlier, verbal part of my appeal, the case manager claimed she would take my case to her superior, but after that failed — who knows whether she actually did or not — I was told to write a letter and send it to some shady post office box address in Wisconsin. That was the second appeal. After that was rejected, I was told to send yet another one, and following the third fruitless endeavor, which included the aforementioned letter from myself and my doctor in New York, I was told I could then petition my secondary insurance for evaluation coverage. During all of their delays, belated return phone calls and long waiting periods between appeal responses, I lost at least five to six months, jerked along all the while, that could have been spent on a waiting list.

… It’s water off my back as long as I maintain the physical and mental ability to excoriate the idiocy and cold intractability of the system, plainly spelled out in black and white, as I am doing now.

The fire drives me on. I’m fairly young and have a strong constitution, and so, although all of this was certainly irritating and makes me think we should rip the insurance industry asunder and start anew, it’s water off my back as long as I maintain the physical and mental ability to excoriate the idiocy and cold intractability of the system, plainly spelled out in black and white, as I am doing now. But imagine the typical transplant patient: weak, infirm, emotionally drained. How much more difficult would it have been for them to go through this labyrinthine process only to get turned away with a few blithe keystrokes? How much more defeating to have gotten that far and have to start over?

Back to the story. Having thus exhausted all options to get coverage for a transplant evaluation with my company’s insurance carrier, I, along with a helpful case manager from my secondary carrier, who had more sympathy in her voice on the first phone call than I got with the other company in six months, began the process by which I am here today. Essentially, the medical director at the second insurance company discussed my case with the transplant director at UPMC and got the necessary approval for me to be seen, assuring the insurance director that the hospital in Pittsburgh had “different techniques” that could be deployed to mitigate my particular set of complications, of which, I will take up next time.

[Artwork credit: “Corporate Lobby” by DeviantArt user ianllanas.]

Clearing the Air: No. 2

The transplant chronicles of a journalist, bibliophile, epistemophiliac and homo sapien.

***

In a perfect society — hell, in any society such as ours claiming to toe the moral high ground — patients who, through no fault of their own, require an organ transplant or any other life-saving procedure should be put on the fast track to receiving swift and affordable access to health care. But not here in the United States of America, where we claim to be the best nation in the world, yet fall wide of the mark on a great many fronts, health care not the least of them.

Credit: "On The Other Hand" by DeviantArt user gilad.

Much like our justice system, when it comes to health care, we don’t put a premium on systems that are efficient, cost-effective and actually serve the best interests of those who need to heal and rehabilitate their lives; health care is a grossly for-profit venture that, even after the implementation of Obamacare, doesn’t go far enough in closing the loophole between those who qualify for Medicaid and disability and low- to middle-class working families who are just one medical disaster away from bankruptcy.

The similarities between our failures in health care and our failures in the criminal justice system deserve to be explored further. Consider the timeless words of Chris Rock on why we have yet to find a cure for HIV/AIDS and other terminal illnesses:

They ain’t curing AIDS because there ain’t no money in the cure; the money’s in the medicine. That’s how you get paid — on the comeback. That’s how a drug dealer makes his money — on the comeback. … You think they’re going to cure AIDS? They’re still mad at all the money they lost on polio. … Curing AIDS, shit that’s like Cadillac making a car that lasts for 50 years. And you know they can do it. … They got metal on the space shuttle that can go around the moon and withstand temperatures of up to 25,000 degrees; you mean to tell me you don’t think they can make an El Dorado where the … bumper don’t fall off? They can, but they won’t, so what they will do with AIDS is the same thing they do with everything else. They will figure out a way for you to live with it. Cause they don’t cure shit. They just patch it up. Get you to the next stop so they can get more of your money.

This is a comedy skit, so obviously it contains some hyperbole, but it also speaks to an important truth. It is true that we have largely eradicated, by way of vaccines, the likes of polio, the measles and chicken pox, but one would have thought in the year 1999 when Rock performed this famous stand-up routine, and certainly in 2016, we would have made more headway on things like childhood leukemia, Alzheimer’s disease, Parkinson’s, Lou Gehrig’s disease, diabetes, sickle cell anemia and many others. I won’t go so far as to entertain any conspiracy theories about researchers actively blocking potential cures for any of these illnesses, but it seems incontrovertible, and not even that controversial, to say that pharmaceutical companies and medical supply companies have more to gain from treatments than cures and that we, as a nation, have propped up a health care system, like criminal justice, that is perfectly content with throwing money at symptoms — and turning profits hand over fist — rather than tackling underlying causes, both medically and those in society at large.

The amount of money Americans pour into the health care industry each year is disturbing when compared with Canada and European nations. The United States spent $2.9 trillion on health care in 2013, which amounts to more than $9,000 per person. Are we getting positive returns on our investment? Hardly. According to the Commonwealth Fund, America was the highest spender on health care among 12 modernized nations, yet ranked last in life expectancy, and while we did well in mortality rates for cancer, we were at the top of the pile in obesity, infant mortality and chronic illness.

David Blumenthal, CF president, was on point here:

Time and again, we see evidence that the amount of money we spend on health care in this country is not gaining us comparable health benefits. We have to look at the root causes of this disconnect and invest our health care dollars in ways that will allow us to live longer while enjoying better health and greater productivity.

That will mean more education, an increased focus on preventative medicine and, of course, more health care reform.

This excerpt from Vox on the same topic is, perhaps, even more sobering:

If the health-care system were to break off from the United States and become its own economy, it would be the fifth-largest in the world. “It would be bigger than the United Kingdom or France and only behind the United States, China, Japan and Germany,” says David Blumenthal, executive director of the non-profit Commonwealth Fund.

Or here’s another way to put it in its (insane) perspective: The US, which has a mostly private health-care system, manages to spend more on its public health-care system than countries where the health-care system is almost entirely public. America’s government spends more, as a percentage of the economy, on public health care than Canada, the United Kingdom, Japan or Australia. And then it spends even more than that on private health care.

The result has been a health care system that has little accountability. Buoyed by free enterprise and in the absence of firm regulations on costs, pharmaceutical companies can literally charge whatever they want for medicine in America. For instance, Nexium was, at one time, $215 for a single prescription in the U.S., compared with $60 in Switzerland and $42 in England. Likewise, doctors offices and hospitals by and large have to pass along exorbitant fees to patients because they know, and they are quite right, that they may or may not get fully reimbursed by private insurance companies or the government, so they up their charges in hopes of getting back a certain percentage of the total. Many hospitals, of course, have to take all comers, including indigent patients, so fees increase over time to offset losses. Add to this unnecessary treatments, services and misdiagnoses, bloated administrative costs, fraud and other inefficiencies, and the unwieldy and broken nature of our health care system becomes self-evident.

To briefly turn now to the American justice system, whereas we should, again, be going after the underlying causes of crime, dereliction and drug abuse and working to keep more people out of jail, silly, nonviolent simple possession laws, a lack of robust addiction therapy options and the proliferation of for-profit “corrections” companies has created another failed system.

Here is what The New Yorker called a “chilling” memo from an ironically-named privatized prison outfit called Corrections Corporation of America:

Our growth is generally dependent upon our ability to obtain new contracts to develop and manage new correctional and detention facilities. … The demand for our facilities and services could be adversely affected by the relaxation of enforcement efforts, leniency in conviction and sentencing practices or through the decriminalization of certain activities that are currently proscribed by our criminal laws. For instance, any changes with respect to drugs and controlled substances or illegal immigration could affect the number of persons arrested, convicted, and sentenced, thereby potentially reducing demand for correctional facilities to house them.

Using the prisons as a profiteering venture is, to state the obvious, antithetical to the idea of “corrections” in the first place. Prisons and jails are supposed to be about the business of helping troubled people rehabilitate their lives; not turning their misery into monetary gain. Although private corrections companies might be the most high-profile example of this cynical and deleterious business, local police department and sheriff’s office certainly don’t get off scot-free and also stand to benefit financially from locking up and processing as many petty, nonviolent offenders as possible to get court fees to help bolster local budgets.

Using the prisons as a profiteering venture is, to state the obvious, antithetical to the idea of “corrections” in the first place.

The common thread in all of this is that individuals, whether in health care or the criminal justice system, tend to get lost somewhere in the monolith, and our health insurance system suffers from acute intractability when it comes to assessing the needs, not of “customers” who are identified only by their policy numbers, but patients as people.

After learning in the summer of 2012 that I needed a lung transplant, my local doctor, who said I should have begun the process “yesterday,” as he put it, referred me to Vanderbilt, and after getting turned down there, I attempted to get a transplant evaluation at the University of Pittsburgh Medical Center on the advice of my long-time physician in New York. But since the hospital was not in-network with UMR, my insurance company at the time, I was forced to get checked out at Duke, which, as I have already said, turned me down. This resulted in using up the second of my two evaluations allowed under my insurance plan.

So, if it’s not clear what happened here, I could have been where I am now two or three years ago — in other words, where I should have been all along — were it not for health care’s in-network and out-of-network provider system. It works in many cases, but in some instances, like mine, patients are not always matched with the right providers in a timely fashion. Weeks after Duke turned me down for a transplant, I learned that UPMC had finally become an in-network provider for my insurance carrier, but of course, it was too late at that point, as I had already used up my two evaluations.

Convinced that I needed to be seen at UPMC, I began an appeal process with my insurance company asking for an exemption to their policy to try to get a third evaluation. Or else, I would have to quit my job and got on disability.

Insurance companies and their representatives are professionals, if nothing else, at using any number of stall tactics and delays in hopes of patients either forgetting about their appeals, losing interest or just dying out, whichever comes first.

As such, I filed the first appeal sometime in the late summer of 2015, and weeks then turned into months as the year dissolved into the waning winter. In my last request, I even attached a lengthy, impassioned plea from my doctor in New York asking that I receive access to health care based on my case’s importance to medical history (as outlined in previous links).

After five or six months of calls, voice mails and letters, the blithe, dismissive, one sentence reply letter I received from UMR was, to put it mildly, an insulting affront to myself as a long-time “customer” and to humanity. Something is seriously wrong in a system that is so intractable and beholden to policy that there is no room for case-by-case exemptions — in other words, exemptions based on the individual needs of actual people.

We are, to them, it seems reasonable to conclude, little more than numbers lost in the monolith.

Next up: The ready and easy way?[Note]http://oll.libertyfund.org/titles/milton-the-ready-and-easy-way-to-establish-a-free-commonwealth[/note]

[Credit: “On The Other Hand” by DeviantArt user gilad.]

Clearing the Air: No. 1

The transplant chronicles of a journalist, bibliophile, epistemophiliac and homo sapien.

***

Now that I have taken a medical leave from my newspaper job in the Knoxville area and relocated to Pittsburgh, in hopes of getting a lung transplant at some point in the future, I thought this would be an interesting opportunity — or, if nothing else, a way to kill time — to record some of my unfiltered thoughts and observations as I go through this process in a way that might not have been possible in print. If you are reading about me here for the first time, you can get most of the background on what I am about to say from this newspaper column and from this post.

Credit: "Breathe" by DeviantArt user mesme8

Credit: “Breathe” by DeviantArt user mesme8

While the immediate aim of this blog series is to write down my ruminations in the days, weeks and months leading up to the transplant — and probably thereafter, if there is a thereafter — I will also roll back time a bit and reflect on what it has been like to deal with this illness through my teens, 20s and 30s — in other words, what should have been, and perhaps in an alternate universe, what would have been, the prime years of my life. But this is not, and I will not allow it to be, a sob story of loss and regret because believe you me, given the limitations, I have squeezed a hell of a lot of life out of 39 years.

To make a long story short for the benefit of those who already know the basic details, I was born with severe combined immunodeficiency and spent 3 1/2 years in a sterile hospital room in New York City, eventually undergoing an experimental mismatched bone marrow transplant in the early 1980s, which gave me a functional, if somewhat irregular, immune system. I developed COPD in subsequent years, and although doctors have some theories as to what might have damaged my lungs, no one seems to have any concrete answers.

When I was young, doctors simply thought I had asthma and would have to write me a “pass” so I would not be forced to run as much as other children during physical education classes. I was conclusively diagnosed with COPD in high school, and as such, I more or less knew that a lung transplant was coming at some point down the road, but I did not know the time or the place. Now, as I write this seven stories up at Family House University Place in the medical district near the University of Pittsburgh Medical Center, those two questions have been narrowed considerably.

I began breathing medicines shortly after the diagnosis, so even as I was getting ready to embark on new life trajectories after high school and again after college, my lung capacity was half or less than that of healthy human beings, so while the degeneration has been a glacial process over these two decades since graduating from high school, it has nonetheless been inevitable. Ironically enough, I began a career in sports writing in 2005, covering football, baseball, track and field and other activities that I could not have participated in myself. 1

After a short time in sports, I moved over to the news department and worked as a news editor for about nine years at publications in Northeast Georgia and East Tennessee and one year as a night editor in Upstate, South Carolina. Not until about five months into my most recent tenure at the newspaper in Tennessee, when a doctor said I needed to go on oxygen at night all the time, did I realize that the disease was starting to catch up with me.

In previous years while covering football and basketball games and other events, I would certainly have to take it slow at times walking up hills and climbing bleachers, etc., but other than the usual maintenance medications, I didn’t have any oxygen requirements until the summer of 2012 when I learned, through what is known as a sleep study, that my O2 saturation levels, unbeknownst to me, had been dropping into the low 80s at night. Any level below 88 percent can, over time, damage the heart and eventually lead to heart failure. Who knows how long before 2012 my nighttime O2 saturation level was dipping below this mark?

In any case, even though I wasn’t ordered to wear oxygen around the clock at this time, strapping on the tube before going to bed that hot summer night for the first time was, pardon the pun, deflating, and was the first step in the long and winding road that led me to the doors of UPMC.

Coming up in post No. 2: The insurance industry as an evil empire.