They say the Chinese character for "crisis" consists of two symbols: one for danger and one for opportunity..,so they say. Since the surgery in 1996, I've had right heart failure, which causes swelling of the ankles. For the first few years, this was fairly well controlled with diuretics, but as it got worse, more and more diuretics were required. The more diuretics you take, the more you pee off, but eventually the diuretics poison your kidneys and reduce their functioning. The numbers crept up and up. A month ago, they were dangerously high, but Andy and Neal came to visit last week, and our spirits brightened.

Michael & Carol ..Michae opens a bottle

This week, the bottom fell out. You've already read about my gigantes cojones and the trip to Mexico. On Monday of this week, I got my blood tests. Tuesday morning I picked up the results by phone and knew I was in big trouble. I saw my cardiologist, conferred with my internist, and we put me on a waiting list for a room at the Miriam. In the afternoon, I kept my sushi date with John Barylick. What a good friend. He drove me to the hospital when the room opened up and stayed with me for several hours. Carol took the train back that night.

Here's the bizarre part. Carol says that on Monday evening, and John reports that on Tuesday afternoon, I was babbling and making no sense. Now, I remember being manic in the ICU in 1980 with my M.I., and I was perfectly aware that I was manic. I remember being psychotic--paranoid, delusional, and hallucinating post-surgery in 1996, and I was perfectly aware that I was crazy, but now I had no idea whatsoever that I was crazy.

The plan was for me to have 4 days of dialysis to give my kidneys a chance to recover from what might have been acute tubular necrosis, and then to see what they could do on my own. My plan was to die quietly.

Two weeks before, without my saying anything to patients, three said spontaneously, "You know how much you mean to me." That was unusual. They were picking up something.

Last week, I knew I had to retire from private practice. Patients there need to be able to say what they want when they want, without worrying about burdening me. I had always thought I would practice forever and die one night, and Carol would tell the patients, "Dr. Ingall has gone to France." I guess that was the easy way, selfish, good for me, with all the pain being borne by others. Now, I had the opportunity to say goodbye to them. It was painful for them and for me. There were tears with many of them from both of us. I began to call on my friends, those remaining dinosaurs who still take the time to talk with patients and families, and not just give pills. They all came through.

It was a time of saying goodbyes. I went to my last monthly poker game. When it was my turn to deal, I broke with protocol. I spoke at length about my deteriorating health. I could not continue to be a regular. People were stunned. Then the support poured forth, in e-mails and in phone calls, in offers to help. It was much more painful and sad than saying goodbye to the Providence Singers, or to biking.

Sometimes I think I have no friends. All my social activity seems to be with Carol and with couples we have known for years, or with family. Suddenly, I realized that I had scores of friends, all of whom wanted to help.

I was in bad shape. Between the heart failure, the kidney failure, the anemia due to the kidney failure, the post-polio syndrome, and the spinal stenosis, I could barely walk half a block. I could no longer ride my motor scooter. It took me 40 minutes to shower and dress in the morning. And I wasn't making any urine. I dreaded seeing the face of my old fellow intern and soldier, Harry Ianotti looking up at me from between my knees as he threaded his catheter into me.

The hospital food did not arrive, so I ate the remnants of a last veal chop that I brought along with me in a bag--the last good food I would ever eat, I sighed. I went to bed in the hospital and quietly said the Kriyas Sh'ma, just as I had been taught to do every night by my Zayde. II wasn't asking God to save me from the malachamovess, or to let me live. It was just a very good feeling. I was so grateful for every good day of my life, for my family, my children, my grandchildren. Blessings on them.


 On to Wednesday