Reassurance

Whenever I hear of the death of someone I know, or of someone close to someone I know, I find myself at a loss.

I don't know what to say to be a comfort or what to do to be useful.

I don't know whether to pick up the phone and call, or send an e-mail, or buy a card, or write a letter.

I don't want to intrude, or overstep, or upset anyone.

I'm sure I'd call at the worst possible moment—when the person is on the other line with the funeral home, or has finally drifted off after a sleepless night, or is just sitting down to the first decent meal in days.

Or I think that I've been out of touch too long, and that it would be inappropriate to reach out now, at such an awful time.

Being on the other side of it for the past week, I have a new perspective on the situation.

I've been touched to receive calls and e-mail messages and cards and personal notes.

I'm grateful for visits from friends and family and neighbors, whether they are people I see to all the time or haven't heard from in years.

I'm delighted to hear old stories about my dad that are new to me—and that instantly confirm something I always knew or suspected about him.

All of these are a comfort, and all are a welcome distraction.

If I can share the wisdom I've recently acquired, it is this:

There is no "right" way to convey your condolences.

You can call, or write, or visit, or make a donation, or send a care package, or attend the funeral service—they are all the right things to do, and it doesn't matter which one (or ones) you choose.

It doesn't matter if you are eloquent or awkward in the process. You will likely be both.

What matters is that you reach across the void—in whatever way feels right—and let the other person know that you, too, feel this loss.

You may feel it directly, if you were close to the person who died, or you may simply empathize with the friend or loved one who has suffered the blow.

Either way, you are offering psychic solidarity.

You are lending strength, providing comfort, and, above all, sharing your humanity.

Whatever you do, it will make a difference.

Trust me.

A Lifetime in Black and White

My mom, my sister, and I are in the process of planning my dad's memorial service, which will take place on Sunday.

I'm feeling a bit of déjà vu because the last thing we planned together was his surprise 80th birthday party, back in April 2006.

For the party, Zach put together a gorgeous collage of old photos that spanned most of my dad's life. We brought it out for people to look at when we sat Shiva for the past few days, and we'll have it on display at the service this weekend.

I love looking at those photos. In one—a veritable mug shot—he seems to be channeling James Dean.


In another, he's a dapper Navy man who looks like Gene Kelly's understudy in On the Town.


One of my favorites is a photo from my parents' wedding, which took place just four months after they met on a blind date. My dad has a glint in his eye and an expression on his face that says, "Boy, did I luck out."


He sure did.

Aftermath

The past week has been a brutal one.

All over the country, as families gathered to celebrate Thanksgiving, ours gathered at my father's bedside one last time. His death was both sudden and protracted, as cruel a conclusion as one could possibly imagine to a life so kind and gentle.

I am quite certain that the full force of his death has not yet struck me and that the blows will come unexpectedly, at odd intervals over the coming weeks and months.

I am also sure that I will not get over the heartbreaking irony that after taking 20 years to "find my voice" and finally call myself a writer, my first published words turned out to be those of his obituary.

From today's New York Times:

ROSEN—Herbert, November 23, 2007, age 81. Herb was a family man first and last: loving husband to Barbara for 43 years; doting father to Jody and Jennifer; adoring grandfather to Lille and Haley; proud father-in-law to Zachary and Nick; faithful brother to Irwin and Mel; loyal brother-in-law; cherished uncle; caring cousin; devoted son. He felt privileged to serve his country in World War II as a Radioman 3rd Class aboard the U.S.S. William J. Pattison. Herb was a co-founder and past president of Marlboro Jewish Center, Marlboro, NJ, and a stalwart of the paper industry for four decades. Throughout his life, he was an honorable businessman, a dedicated mentor, and above all, a steadfast friend. Those who knew him will remember and celebrate his warmth, optimism, perseverance, and generous heart. A memorial service will be held Sunday, December 2, at 2:30pm, at Riverside Memorial Chapel, 180 West 76th St. Donations in his name may be made to the 92nd Street Y, his home away from home.

Hospital Waiting Rooms: 20 Survival Tips

Emergency rooms and hospital waiting rooms are dreadful places to be when a family member or friend is sick or injured. They are stressful, stultifying, and enervating—as inhospitable as can be.

But if I've learned anything from the countless hours I've logged in these palaces of purgatory, it's that a little preparation can make a big difference. I hope you never have occasion to use these tips, but I offer them as strategies for keeping what is inevitably an unpleasant experience from becoming abject misery:

1. Bring snacks. Good snacks, like nuts or fruit or energy bars. It is axiomatic that healthy food cannot be found anywhere in or near a hospital. The later it gets, the truer this is.


2. Bring change, in case you want a bad snack from the vending machine. Also handy for payphones and parking meters.


3. Bring a bottle of water. Waiting rooms can be hot and stuffy. And if you aren't eating right, it's easy to get dehydrated.


4. Bring stuff to read. Best bet is to bring an assortment—a newspaper, a magazine, a book, maybe even something from work. You may have no head for a newspaper but be in just the right frame of mind for a magazine story. Or you might want to escape into a novel for a little while.


5. Bring your phone book, in whatever form it exists. You may want or need to call family or friends.


6. Dress in layers. If the waiting room isn't hot and stuffy, it's probably cold and drafty.


7. Bring at least a one-day supply of whatever prescription and over-the-counter medications you take. It's easy to get stuck overnight, especially in the emergency room.


8. Bring an iPod or [your portable music player brand here] and a comfortable set of headphones. Waiting rooms are the natural habitats of screaming children, loud talkers, and painfully bad TV.


9. Wear comfortable shoes. Chair shortages are common.


10. Scout the bathroom options early. Know where to go when the one nearby runs out of toilet paper or is overdue for a cleaning.


11. Carry tissues and napkins. If you don't need them, someone else will.


12. If you are so inclined, bring a crossword puzzle, or your knitting, or a Sudoku book to pass the time.


13. Bring a pad and a pen. You may need to take notes when talking to a doctor, nurse, or technician. You may want to write down the phone number at the nurses' station. You may think of 10 things to add to your to-do list. Or you may just want to play hangman.


14. Bring the charger for your cell phone, even if you don't expect to need it.


15. If you wear contacts, bring your back-up pair of glasses.


16. Bring mints or breath strips.


17. Bring your appointment book, in whatever form it exists. You may need to rearrange your schedule for the following day or week.


18. Wear comfortable clothes. Think drawstring waistbands and cozy fleeces.


19. If you have a long wait in front of you, find the blood bank and donate a pint. It's one of the most constructive things you can do.


20. Keep your sense of humor. A well timed joke can break the tension and give everyone a much needed respite from all the stress.

Simpatico

Tonight I attended a short talk on "The Role of Compassion in Health Care Today" by Herb Pardes, the president and CEO of NewYork-Presbyterian Hospital. (And no, I don't know why "NewYork" is all smushed together like that.)

After spending so much time in the throes of the medical system, it was heartening to hear someone in his position speak with great conviction about putting the care back in health care.

He opened his talk by stating, very simply and persuasively, why everyone is—or should be—invested in the state of our health-care system:

"No matter who you are, you're a patient or potential patient."

Exactly.

When he talked about his goals for health-care culture and about the qualities he wants to see in every member of his hospital staff, he used words like "humanistic," "responsive," "sensitive," "attentive," "empathic," "understanding," "caring," and "genuine."

Those are beautiful words.

He described how important it is for doctors and nurses and technicians and every other kind of caregiver to genuinely understand the perspective of the patient and of the patient's family:

"Something about being understood specifically is invaluable."

That, he said, is the key to making someone feel better.

Indeed it is.

Worked like a charm on me.

There Is Something You Can Do

When my dad arrived at the E.R. on Thursday evening, his blood pressure was so low it barely registered. His hemoglobin, which should be almost 14 grams per deciliter, had sunk to 6.

What sustained him overnight and through surgery the following morning was the kindness of strangers.

Strangers who found an extra hour in their busy lives, rolled up their sleeves, and gave a pint of blood.

There are at least five people out there, somewhere, who collectively saved my father's life.

I have absolutely no way to thank these anonymous heroes, whose only rewards were a cup of juice and a cookie and maybe an "I Gave Blood Today" sticker. They could not possibly have known how their selflessness would radiate outward until it reached a nondescript emergency room late one night, where it altered the destiny of one beloved man and his family.

If you have never given blood, I implore you to start now. To see if you are eligible, click here.

To find out where to donate, click here.

If you need further persuasion, here are 10 reasons to give blood plus answers to the top 10 excuses for not donating.

It took me years to give blood. First I didn't weigh enough. Then I was too squeamish. Eventually, I was shamed into doing it. I had to organize a blood drive at work, and there was no way around it—I couldn't exhort people to open a vein if I wasn't going to do it myself.

It turned out to be surprisingly easy, amazingly quick, and practically pain-free. And very, very rewarding. Although I haven't been eligible to give blood since my first diagnosis back in 2001, I am hoping to re-qualify someday.

If you are already a regular blood donor, you have both my admiration and my gratitude. If you need a bit of extra encouragement to make the time, or to stare down the needle, just imagine someone you love needing a life-saving transfusion.

Now imagine the stranger who could have donated that blood but didn't.

Indebted

Late Thursday afternoon, one of my dad's regular aides noticed that something was amiss.

I am going to hug the stuffing out of that woman the next time I see her.

Her attentiveness got my dad to the E.R. that evening and into emergency surgery the following morning.

He is doing remarkably well and resting as comfortably as possible in the surgical intensive care unit.

There is much more to the story, of course. But for now, I just wanted to share my gratitude for someone who gives her own version of intensive care every day and who, no doubt, is grossly underpaid and underappreciated for the effort.

Thank you, Sharon.

You are, quite literally, a lifesaver.

Reflections on the Austerity Diet

I'm at Day 37 of my austerity diet and still going strong.

As you might expect, I'm finding it much easier now that I'm over the initial hump. Getting into the habit is the hard part—maintaining it is far less onerous. Momentum is my friend!

My sense is that a few key things have helped me make a success of what could quite easily have been a disastrous effort to upgrade my diet and downsize my cholesterol count:

1. Three simple rules. I haven't been counting calories or fixating on fat content. Instead, I decided to abide by three straightforward restrictions: no sugar, nothing fried, no junk/processed food. It's easy to tell if something is sanctioned or not, and I don't have to spend any time on should-I-or-shouldn't-I debates. If it's any (or all!) of the above, I don't even consider it.


2. Immediate positive feedback. Fluke or no, getting a normal result on my cholesterol test midway through the month gave me reason to think that my basic approach was sound. And once I had that feedback, I was all the more determined not to backslide.


3. Healthy snacks on hand. Whether I'm at work, on the subway, or out on the town (wishful thinking), I now make sure I've got something to keep hunger—and therefore temptation—at bay. Fruit, nuts, and plain old water have saved many a day.


4. Unhealthy ones out of sight. It turns out that candy and potato chips—which I like as much as the next person—don't really tempt me much these days, although they certainly were culprits in the past. The hardest things for me to resist are ice cream, cookies or cake, tortilla chips, and French fries, and I'm doing my best to keep my distance. Just being aware of what constitutes my personal Kryptonite means I can focus my resolve on these few items, instead of feeling deprivation at every turn.

Now that I've made it this far, I want to ratchet down the austerity just a little bit to make my diet truly sustainable. That means allowing myself to break the rules, within reason, at regular intervals. It would be easy to give myself an exemption every week, but to start I'm going to strive for just twice a month to underscore the point that these truly are treats, not entitlements, and therefore ought to be rare.

I'm not going to fixate on the treats, deciding days or weeks in advance exactly what they're going to be. And I'm not going to force them, either—if the opportunity doesn't present itself or the urge doesn't strike, so be it.

If this is going to work as a long-term plan, it can't be over-engineered. It has to be easy, flexible, and self-reinforcing.

So far, so good.

Your Tax Dollars at Work

This week's mail brought a cheerful document called "Your Social Security Statement," signed by Commissioner Michael J. Astrue and "Prepared especially for Jody R. Knower."

Oooh. I'm all a-tingle!

Besides giving a recap of my earnings since high school, the statement confirms that I have amassed enough credits to qualify for various benefits.

For example, I'm already guaranteed to qualify for Medicare once I hit age 65 (assuming Medicare still exists at that point).

And I already qualify for disability benefits—if I suffer a disability, that is. The Social Security Administration is a bit eager on this front:

"If you become disabled right now"—right now? while I'm reading this happy missive?—"your payment would be about $1,856 a month." (My total earnings for last year were so low that this would actually be a significant raise.)

But here's the best part:

"You have earned enough credits for your family to receive survivors benefits." (Missing apostrophe, anyone?) "If you die this year—"

Why does this sound like some kind of sales pitch? Act now and take advantage of this special offer!

I'd better get a move on if I don't want to miss out on this incredible deal: If I keel over in the next eight weeks, Zach will get a whopping $1,923 a month.

Beginning in 2033, that is.

Thank you, federal government, for this little actuarial valentine.

I hope you won't be too offended if I decline.

Blowing Smoke

Zach and I spent the day visiting my dad at the rehab hospital. On the way out, we passed an elderly gentleman sitting in a wheelchair outside the building entrance. It was a chilly evening, the temperatures somewhere in the 40s, and he was out there in short sleeves, with no jacket or blanket or hat. He had a cigarette between his lips and was extracting every tobacco molecule he could, sucking them in with the force of an industrial vacuum cleaner.

Last night, I met a group of friends for dinner. One of them had cigarette breath when she arrived at the restaurant. Later, as soon as we had finished our meal, she immediately lit up on the sidewalk outside.

These two people are at least 50 years apart in age and probably have absolutely nothing in common except for a tobacco addiction. And in that they have plenty of company: Tonight I learned that 45 million American adults smoke.

That's more people than live in the entire state of California.

According to the American Cancer Society, not only can smoking cause lung cancer—it is also a risk factor for some forms of leukemia and for cancers of the kidney, liver, pancreas, bladder, esophagus, stomach, cervix, nose, throat, mouth, and larynx. Then there's heart disease. Not to mention emphysema, pneumonia, and chronic bronchitis. Nearly twenty percent of all deaths in this country are attributable to smoking.

Smokers who have surgery have a lower survival rate than nonsmokers and have a greater likelihood of complications, according to a 2004 Surgeon General's report.

My dad gave up smoking 43 years ago and is still suffering the long-term effects of his 20-year habit.

I've never smoked, so I can't begin to understand the allure of tobacco or the grip it has over those who have succumbed. But I know that whatever benefits one derives from lighting up are no match for the anguish of illness that so often follows.

The Great American Smokeout is coming up later this month on Thursday, November 15th. If you are a casual, regular, or chain smoker, I hope you'll consider jumping on the bandwagon and making a commitment to quit.

If you need help making the decision or following through, check out the terrific resources offered by the American Cancer Society and the Centers for Disease Control and Prevention.

There are innumerable good reasons to give up smoking. Take your pick.

And then make it happen.

Because It's Been a While

Today's installment of Fun with Medical Bills:

Over the summer I had the pleasure of visiting an outpatient radiology center to have a PET/CT scan on one day and then, about a month later, a mammogram, breast sonogram, and pelvic ultrasound.

I needed to call the billing office this morning because of some confusion about the way my insurance companies were billed for these tests. In the process of straightening things out, I learned that there was a credit of $215.00 on my account.

A credit? Really?

Awesome!

It turns out that the radiology center had billed my old insurance company $3,750 for the PET/CT. The generous folks there had also required me to pay $225—a pretty exorbitant co-pay—before I had the test.

Lucky for me (in theory), the center was in my old insurance company's network, which means that the prices of its services are governed by contract. In this case, the contract amount was $1,000.

My insurance company deducted a $10 co-pay (note that $10 is not even close to the $225 I was charged), and then paid 100% of the balance, $990. The radiology center wrote off the difference of $2,750. (If you think the markup on liquor is bad, be grateful that you don't have to pay retail prices for medical care.)

So the radiology center had now received $1,215 on a claim for which it was entitled to $1,000. This was back on August 22.

What the billing folks should have done was send me a refund of $215. (Hence the credit on my account.)

They didn't.

That's because they didn't get all the money they'd hoped for from my other insurance company for the tests I had the following month. (In the interim, my primary insurance lapsed. I now have coverage only through what used to be my secondary insurance but is now, simply, "my insurance," although I've called it "my other insurance" here for clarity. Got that?)

My other insurance paid for my mammogram and breast sonogram but balked at the pelvic ultrasound. So the radiology center's $450 claim for that particular test had been denied and is now under appeal.

For some reason, the billing folks thought it was OK to hang onto my $215 credit (plus the interest it's been earning for the past 10 weeks) as some sort of security deposit against the outstanding $450 claim.

That's not the way it's supposed to work.

They're supposed to fight it out with the insurance company and then bill me for whatever they don't collect. (And I may not even be responsible for the difference—it depends on whether the center is in or out of the insurance company's network.)

When I protested, I was told that this was the billing department's standard practice.

When I protested further and got nowhere, I asked to speak with someone else—someone who could override the policy.

"There's no one else," the billing representative said.

I explained that I understood that she couldn't help me and that I no longer expected her to, but that there had to be someone higher up with the authority to release my $215.

She said there wasn't.

"Really?" I asked.

No one at all?

No, she said. Just the president.

So I asked for the president's name and contact information.

And that's when she put me on hold.

A minute or two later she came back on the line and said she'd been instructed to tell me that "management" would review the status of my refund.

I'm guessing that, in this case, "management" is a 10-letter word for "president."

I've got my own four-letter word.