First Do No Harm

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My doctor, who is a wonderful person and a committed professional, tells me that I am pre-diabetic.  I thank her and tell her that I am also pre-dead and that these are things that should provide a sense of accomplishment to her.  She is unconvinced.  I ask her whether she would be willing to prescribe one of those wonder drugs that would make me pre-fat, or even post-fat, and she says that Maccabi insists that I actually be diabetic to get one of those.  I tell her that I will try harder and we part ways.

The episode reminded me of my historic visit to the best cardiologist in Miami.  For reasons that I will explain later, I am very reluctant to visit doctors.  Perhaps because I associate them with death, disease, and a lack of punctuality.  My wife, on the other hand, believes that regular pilgrimages to physicians have a sort of talismanic effect on health.  She has patronized every type of specialist medical school can conjure.  “I have an appointment with a gastrointestinal auto-immune endocrinologist focusing on plantar fasciitis,” she tells me happily, like she scored a private interview with the Rebbe.

Some years back, for her birthday, because she loves me and because I make certain at all times that she has anything her heart desires, she tells me that she wants nothing but for me to visit this cardiologist, with whom, she explains sweetly, she has already made an appointment.

When my fury abates–about fifteen seconds later–I agree to visit.

He is a trim man with a white coat and no body fat.  Not a single white hair is out of place.  He is justifiably smug, having achieved the pinnacle of professional accomplishment.  He begins our conversation by telling me I am overweight.

This is the wrong way to start a useful dialogue with me.  I tell him that he has unpleasant breath and the aura of a child molester.  Actually, I only imagine telling him that, but even thinking it provides a small measure of satisfaction. I feign shock.  “Really?” I ask. “I had no idea.  Thank you.”

He asks if I smoke.  No.  He asks if I drink.  No.  He asks if I exercise.

“God, no!” I say in horror.  He asks why and I tell him about Jim Fixx, who wrote the book that popularized running for a generation of Americans and died of a heart attack at the age of 52.  While running.  I relate my philosophy that one who is not being chased should not be running.  “Only guilty people run,” I explain.

He tries to administer a stress test, but I demur because of the danger.  He tells me that fewer than .001% (or one in ten thousand) have fatal adverse consequences from stress tests.  I explain to him that in a world of eight billion people, .001% is 80,000, more than would fit in Yankee Stadium.  The odds are not in my favor.

He uses the time that we would have wasted on a stress test to expound on the “benefits” of exercise.  By elevating the heart rate,  and making the heart work harder, he says, the heart becomes stronger, healthier, and better able to withstand disease.  I nod.

After a battery of non-life-threatening tests (blood pressure, blowing up balloons, EKG, etc.), he is ready to share his findings.  We retire to a well-appointed room with a large walnut desk that I covet, and he once again tells me that I am fat.  I think he says “morbidly obese,” as if a plain, unadorned “obese” wouldn’t have been sufficient to relay the message.  At least he is consistent.  “When one is as overweight as you,” he smugly declaims, “the heart must work twice as hard to deliver the blood throughout the body.  This results in a thickening of the wall of the heart, which is not to be desired.”  He tells me that the tests have detected a slight thickening of my heart wall.

I patiently explain to him, as one would to a dull third-grader, that this is all by design.  By making the heart work harder, I am assuring that it is becoming stronger, healthier, and better able to withstand disease.  And I don’t even need to sweat.  He stares at me blankly.  I go home.

I thank my wife and tell her everything is fine.  We go out to dinner and I skip dessert.  She is happy.

This week’s Torah portion is Vayikra, beginning the book of Leviticus.  There is not a thing in it that has anything to do with weight loss or medical care.  So this may be the only thing you read this week on these topics; pay attention.  I am also well aware that enzyme inhibitors and statins are responsible for my continued survival to this point.  I am grateful to the medical science that invented them and the physicians who prescribed the right drugs and dosages.

So why do I resist visiting them?  Economics. Doctors are like viruses.  The most advanced virus wants to live in your body and make you sick for as long as possible.  If it mutates into something too virulent and kills you, it deprives itself of a host and perishes along with you. On the other hand, if it evolves into something easily resisted by the body, it suffers the same fate.  So it wants to keep you sick without killing you.

A profit-maximizing medical profession has the same goal.  If you are well, limited revenue.  If you are dead, zero revenue.  If you are constantly beset by all manner of lingering ailments . . . kaching!  Buy a vacation home.  As my sweet and long-suffering wife demonstrates, if you visit enough doctors, and then the doctors to whom they refer you, and, the exponential number of referrals of the referrals, something will be found.

I am not criticizing or even finding fault.  It is a simple syllogism:  healthy and dead people do not need medical care; doctors make money providing medical care; doctors do not want you healthy or dead.

From reading prior posts, you know that I have alienated every Rabbi whose synagogue I attended by explaining to them that it is a violation of the Torah to deliver a weekly sermon.  From this post, you are able to discern, if you are perceptive, that my relationships with the doctors in the communities in which I lived were tenuous (a number of them being resentful, for some reason, of the virus analogy).  Having practiced law for many, many decades, you can only imagine my opinion of attorneys.  And you all are the beneficiaries, because I just get to sit alone, all alone, at my computer and type.

By the way, if you enjoy the discussion of exercise, weight loss, healthcare, and theology, feel free to purchase my book The Manly Man’s Diet For Manly Men, available on Amazon.  It is the best (and funniest) diet book ever written.  What do skinny people know about losing weight?  It is also a perfect Passover reward, birthday present, shiva gift in lieu of food (especially if the deceased was overweight), or anniversary token.  Among other things, it has a formula for perfect hard-boiled eggs.

In an abundance of caution, let me add, a bi gezunt, kain ayin hara.