Back in 2014, eight years ago, I noticed while lecturing at law school that I was more inclined to cough when I took deeper breaths. So I took less deep breaths. D’uh. But over time, the breaths became even less deep, and I went to a lung doctor, a pulmonologist. He was very highly regarded, affiliated with an excellent hospital in Los Angeles. But he made jokes and short shrift of my perception that something was not right. After viewing my CT scan, he said “It’s nothing, just some schmutz (dirt) in your lungs.”
The joker was wrong, and I felt it. I knew he was wrong. Something was not right. Eventually, a more serious and much wiser pulmonologist diagnosed my condition correctly: interstitial lung disease. My lungs were not processing oxygen as effectively as healthy lungs do. By volume, dry air is comprised of 78.09% nitrogen, 20.95% oxygen, 0.93% argon, 0.04% carbon dioxide, and small amounts of other gases. If you process just a little bit less oxygen than you should — e.g., saturation of 80 percent instead of 87 percent and preferably over 90 — your brain will be affected, and you soon will die.
To deal with my progressing illness, I eventually bought a portable oxygen concentrator, the Inogen One. It pumps pure oxygen into you via cannuli, that nursing-home thing that goes into the nostrils. I bought their main model with five settings, and I began minimally with one liter. As my conditioned worsened over time, I increased the setting to two liters, then to three, and eventually to the maximum five. That was great, but it was no cure. My condition continued worsening, as expected.
By a year ago, my pulmonologist started sharing with me the bad news that I needed to start thinking about a lung transplant. The problem with that, besides the obvious danger of any severe surgery, is that half of people with transplanted lungs make it fewer than six more years. Although 93% of recipients make it one year with the new lung, the body’s own defenses — the antibodies that attack foreign infections like viruses and bacterial infections — also attack transplanted organs, thinking they are foreign dangerous invasions. Heavy medications are prescribed, including CellCept (mycophenolate mofetil) and Prograf, to overcome and reduce the protective antibodies and thus to prevent or reduce chances of organ rejection, but that treatment also leaves the body markedly weakened in fighting off regular viruses and other infections. For example, it is believed that Gen. Colin Powell died of COVID, despite his having worn a protective mask regularly and having received all prescribed immunizations, because he was on such medications that left him severely immunocompromised.
By January of this year, it was time for me to explore lung transplantation. It no longer could be avoided. But there was a major COVID outbreak in Los Angeles, and I wanted to avoid going to any hospitals at the time; their morgues were overcrowded. Thanks, Chinese communism. As the surge attenuated in March, I scheduled meetings at three hospitals to meet with their respective lung-transplant teams, so I could decide whether the time had come to transplant and which place would be best for me.
On March 21 I went to my first appointment. I met with their expanded lung-transplant team. After they checked me out and described their program, the director told me “We are not a prison, and I cannot lock you up here against your will, but if you don’t check yourself in right now, I cannot assure you that you will wake up tomorrow.”
I checked in that day and would not come back home until four months later on July 20. Inasmuch as the hospital did not allow haircutters in because of the pandemic, I went four months without a haircut, leaving me looking like a caveman. I never got to the other two appointments and never got to choose. Rather, it was a variation on Patrick Henry: “Give me a lung, or give me death.”
I was not yet “out of the woods.” They do not do lung transplants for people dying of lung disease unless you “qualify.” With a shortage of available lungs for transplant — and other practicalities — they will not, for example, implant a new lung into someone otherwise dying of terminal cancer or too weak to withstand the procedure and its aftermath. So I had to “qualify” by passing certain physical tests of basic strength. Unfortunately, my years of reduced lung capacity and oxygen saturation, compounded by my not going to the gym as COVID emerged into a full-blown pandemic, had left me seriously deconditioned. The hospital’s physical therapist was not helping me meaningfully improve, and I would not receive the transplant if I did not get reconditioned, so my wife Denise found me a personal trainer who cost me a small fortune to come to the hospital three times a week. He was great, and he got me into something approximating decent enough condition to qualify as a lung transplant recipient. That process took more than a month of intense exercising.
The lung transplant team believed in my determination to meet their qualifying standards, so they authorized my continued stay in the hospital while I worked to qualify. Along the way, there were CT scans, X-rays, MRIs, whatever they got. One exam perilously suggested my diaphragm was not working, which would disqualify me. On an alternative test days later, they found good life in the diaphragm. Thank G-d. There were other concerns that arose amid the plethora of tests they put me through, but one-by-one G-d blessed me miraculously with positive results — or I should say “negative results” — and I qualified.
Next we had to wait for a suitable lung. Not every lung will do for every patient. For example, a small person cannot receive a big lung, nor a big patient a small lung. And I had refused any lung donated by a smoker. There is a national lung transplant waiting list. UNOS (the United Network for Organ Sharing) manages the Organ Procurement and Transplantation Network (OPTN). This computerized list includes all the information doctors need about everyone who is waiting for donated lungs. Because I was in a hospital, not “just” waiting at home, and met other criteria, I was higher urgency on the waiting list, top tier. Miraculously, my new lung showed up only ten days after I qualified to receive one. Some qualifying candidates have to wait months. Some die while waiting. I got my lung transplant on May 20 — two months from the day I was admitted into the hospital.
I learned to truly hate hospital beds. And, restricted by my own religious beliefs and practices to a strictly kosher diet, I came to get sick of the same boring food choices each meal. They cooked the flavor and moisture out of the salmon, the brisket, everything. It all had the texture of fine leather. But at least I was alive.
In many cases like mine, they transplant only one lung, leaving one of the diseased other lungs in the recipient. That way they can transplant two patients from one donor. They say the diseased lung does not spread its illness into the new healthy lung, and you need only one lung to thrive. Alas, during my surgery, the surgeon paralyzed one of my two vocal cords, leaving me with virtually no voice. That sent me for special treatment by a uniquely skilled otolaryngologist who ultimately injected a special filler into my paralyzed vocal cord, miraculously restoring my voice. I now am undergoing therapy with a Speech Language Pathologist to restore my voice’s resonance and strength, and I just delivered five divrei Torah (sermons) to my congregation over Rosh Hashanah and Yom Kippur.
They next found a mycobacterium in my old diseased lung and put me on a horrible antibiotic called “amikasin.” That medication left me half deaf — literally, and seemingly permanently — so I had to find an audiologist who has fitted me for hearing aids. My hearing had been fine before, but now I need hearing aids like my grandfather’s. Thank G-d, I can mostly hear again, and TV closed captioning helps a bunch. I don’t need the little sign-language person in the small circle on the top of the TV screen or the Nelson Mandela clown. And then there has been rehab: learning to walk unassisted again, to climb stairs, to amble around without thinking about it.
I now live on a ticking time table. No one can predict how long a body will accept an implanted foreign object, but the situation still is better than being poked in the eye with a screwdriver or being dead. For me, I now am on borrowed time, enabled to serve G-d longer, to fulfill more Torah commandments, to help people with my pastoral services, to teach Torah again via Zoom, to role model. I can live to see Nancy Pelosi booted out of her perch, the gavel stripped from her hands. I even have a ream of paper ready to rip when she gets ousted as the GOP takes back the House in a few weeks. I can live to see another two Israeli elections each year for the next decade or two.
And I can write again.
I don’t need vocal cords to write, nor hearing aids. Those are bonuses. Living is a bonus. I no longer need my portable oxygen concentrator. Along the way, I have learned to appreciate the 21% oxygen in the air as I never did before, each and every breath I take. I have learned how truly special a voice is, and how it is a gift from G-d to be used for righteousness (to encourage people, to compliment, to pray, to inspire, to teach, to express love) and not for evil (gossip mongering, stirring up hate wantonly, insulting others, downplaying good with cynicism, or just plain prattling on endlessly about nonsense).
I have learned to appreciate G-d’s great gift of hearing: “Hear O Israel. The L-rd is our G-d. The L-rd is one.” Deuteronomy 6:4. To avoid listening to gossip or evil talk but instead to listen to Torah classes online and to listen to inspirational songs ranging from those of RabbiShlomoCarlebach and Safam to Garth Brooks (“Some of G-d’s Greatest Gifts Are Unanswered Prayers,” “The Dance,” “The River,” “If Tomorrow Never Comes”).
I have learned to appreciate every moment of life as I never have before — and I always have loved my life. To appreciate oxygen.
To appreciate Ms. Rochel Sylvetsky and her team for opening the “pages” of Arutz Sheva / Israel National News to me, allowing me to share my “voice” with so many thousands of my devoted readers. To appreciate my congregants who give my life so much more meaning than I ever could give them. And to appreciate my professional colleagues, dearest friends, kids, and wife. We all should be prepared to love good and to hate evil if tomorrow never comes.
Adapted by the writer for Arutz Sheva from a version of this article that first appeared here in The American Spectator. To attend any or all of Rav Fischer’s weekly 60-minute live Zoom classes on the Weekly Torah Portion, the Biblical Prophets, the Mishnah, Rambam Mishneh Torah, or Advanced Judaic Topics and Texts, send an email to: [email protected] (Please note that Rav Fischer’s classes will be on hiatus until mid-Nodember, when he is scheduled to complete pulmonary rehabilitaion.)
From Arutz Sheva: רפואה שלמה במהרה עמו"ש