April 10, 2005 - The doctor tried to avoid the using the word as he stepped through the CT scan images on his laptop. The left kidney appeared and then the spherical growth the size of a ping pong ball attached to the surface of the organ. He called it a growth then a cist or tumor. He was trying to convey the seriousness of the diagnosis without using the word that my generation understood as a death sentence. Finally, after hearing him use every euphemism he could think of I broke the ice. “Assuming the growth on the left kidney is cancer”, I said, “what is the next step?”

Again the area around the bush was being carefully beaten. “Some would advise a biopsy where we push a needle through the abdomen wall and take a sample,” he said, “but that risks seeding malignant cells when the needle is withdrawn. I think that the answer is to go directly to surgery. We have to assume that the growth is malignant.” He still would not use the word cancer or describe the unnatural structure growing on the kidney as a tumor.

The doctor is one of the foremost urologists in the Midwest practicing at a clinic well known as a cancer treatment center. He begins to describe the alternative approaches that surgery can take. “It depends on how much of the kidney meat you want to save”, he says. Because the tumor is located so close to the part of the organ that collects the urine and sends it to the bladder reconstruction of the kidney after removing the tumor is job that only on surgeon in the country will attempt. That man practices in Cleveland. It is regarded as experimental surgery and won’t be covered by my health plan.

There are two approaches to removing the kidney. One is to make a small incision in the abdomen wall and remove the organ by laparoscopic surgery. Neither my doctor nor my hospital is certified to perform that procedure. There is a doctor in the state capitol that is. Otherwise surgery will involve a large incision big enough to let the doctor reach inside and get the kidney out. Again it is regarded as experimental surgery. Again it won’t be covered by my health plan. The decision is made for me. The surgery is scheduled for three weeks off. There is much to do. Jury trials are coming up and I have thirty-five cases to settle or try. I have to arrange for another lawyer to cover my office while I am gone.

There is one other thing to do. I have always hoped for the best but prepared for the worst. I have to write my living will and appoint a surrogate to make decisions if I am unable to. Terry Shiavo’s case has taught me that lesson. I will write out instructions for the disposition I wish to be made of the body and for any memorial service my family and friends decide to have.

It has been an experience that has brought home the extent to which our health care decisions are driven by economics and our insurance plans. We like to say that America has the best health care in the world. The fact is we have only that level of health care that we can afford to pay for and the price keeps going up. We can do better than that. Every other industrialized society does.