David Levine - today
Here's how things
have changed.
I was born in 1941, the eldest of four. So I remember the late 1940's somewhat, and the 1950's very well. In those days people married and had kids earlier than now. My Dad was born in 1915, my Mom in 1917, so they were parents at ages 26 and 24, and parents of four at ages 34 and 32. So I remember things they said probably by the time I was 10, and they were like 36 and 34.
Although the modern medical era had been born before I was, medicine wasn't very advanced compared to now. The invention/discovery of penicillin was an early sign of miracles to come when I was a kid. We were down the shore in Beach Haven, NJ, for the summer – my Mom took care of us kids and my Dad came down on weekends I stepped on some glass, probably, in Little Egg Harbor Bay and cut my foot, although I was convinced that a crab had bitten me. We got it sewed up by a local doctor. Was that the time it got infected, or was that from some other accident? I don't know. But whichever time it was, I got a suppurating infection of my foot.
In former days, that infection could have been catastrophic. But now we lived in the penicillin era. I was taken back to Philadelphia, I'm pretty sure it was to the Graduate Hospital where my Dad, a neurosurgeon, often had patients, and I was treated with penicillin. Those weren't the days when they gave you pills, or when you got your intravenous meds by IV's, and it wasn't even the time when you got spaced out doses of penicillin with lidocaine that lasted 12 hours or more. Nope, it was the era of four doses a day by intramuscular injection, and it hurt like hell, as I remember it. My Mom left the other kids at Beach Haven, under the care of whom I don't know, and stayed with me for the few days it took for the infection to be cured. All this, for a foot infection of a wound.
The shots hurt, so when the nurse showed up, I cried and protested. Then my mother got herself together and talked to me quietly and convincingly, and said I'd have to take the shots anyway no matter what I did, so why didn't I try to be brave and not protest? The next time the nurse came in I smiled a big false smile and turned over on my belly to get my shot in the ass. The nurse said, “What's got into him?” She gave me the shot and I absorbed the pain quietly. Amazing what my mom could do when she put her mind to it.
But what modern medicine hadn't gotten around to yet was heart disease. There was a lot of smoking, and who knew about cholesterol? I remember my parents saying, when something came up about heart attacks, I guess, “Remember Joe Ziggerman?” And they shook their heads. I asked what happened to him and they said that he “dropped dead” of a heart attack at age 39. “39,” they said. 39.
We lived at a house in West Philly until I was in 8th grade, in a semi-detached house, 422 South 47th Street, just down from the corner of 47th and Osage. Our front door opened onto a little landing that we shared with the house next to ours, where the Barkan's lived. Ben Barkan was a red-headed lawyer of Democratic persuasion, and they had two kids I remember, it might have been three. Ben was a well-built man, his wife Sylvia was an open-hearted and expressive woman with dark hair who hated Republicans. It was the McCarthy era, and tensions were high. I think they were ADA members, Americans for Democratic Action. Ben was also a tennis player, although we never played with them. It must have been after we moved to Wynnewood in Lower Merion Township in the suburbs when I heard that Ben had died while serving in a tennis game, dropped dead of a heart attack. I remember one dinner party at my parents' house in Wynnewood, I'm pretty sure it was when I was home from my freshman year at Harvard, and my parents had invited Sylvia, who was there alone, a widow.
Just over a block away, at 46th and Osage, lived our close friends, the Levins. Father and mother were Herb – another liberal lawyer, although one more practical than Ben – and Beck (Rebecca) and their three children, Bob and Susie and Larry. I don't know when it was that Herb had his heart attack, but I know it was after Susie had died of leukemia, which would have been fairly readily treated if she had had it today, because treating childhood leukemia is one of the great achievements of modern medicine. When Herb had his attack they called my Dad and he took Herb down to Penn, not too far away, and Dad protected him from the residents as best he could in the ER. Dad said that the resident kept yelling at Herb, “What's your name?” Dad said, “I'll tell you his name, just treat him.” Of course they didn't have much to treat him with then, maybe give him some oxygen. But thank God he survived. Still, that's what lurked in those days.
When we moved out to Wynnewood, we lived in a new subdivision of what had been a rather large estate a block down from Montgomery Avenue and North Wynnewood Avenue. (Wynnewood, I remember from the plaques, “Named for Thomas Wynne, physician to William Penn, and first Speaker of the First Pennsylvania Assembly.” At least that's how I remember it.) Our little subdivision had Jews, all Jews, in the WASPy Main Line that had already seen Jews in Merion, but now had come to Wynnewood. I remember sitting with my parents in the real estate office as they were buying our house, the Jewish developer telling Mom and Dad the names of the other families who had moved in – Herb Lipshutz, the plastic surgeon, the Simon's, the Lowe's, the London's, others. The real estate agent who was handling all the sales commented, “Where are the O'Connor's and the Kelly's?” The developer and buyers turned their heads toward him and acknowledged the comment with polite and tentative laughter. Neighborhoods change, it can seem like an invasion, I guess, but for real estate agents, it's just business.
So we moved in and Mom and Dad stopped paying four tuitions to Friends' Central School and sent us to the very good public schools of Lower Merion. We made friends with our neighbors. One night my Dad got a call from our next door neighbors, the Simon's, and Dad went and found the father of the family dead in his bed from a heart attack. I was gone to college at the time. Somewhat later they got a call at night and Ed London was dead in his bed as well.
In the 1950's the NIH was formed, on the initiative of Mary Lasker and Democratic Senator Lister Hill of Alabama – a monumental achievement of lobbying a government to do the right thing. In the coming decades, national health policy targeted heart disease, cancer, and stroke as the big killers. Billions of dollars went into direct governmental expenditures and grants to university researchers. We are now 60 or 70 years out from that beginning. It is the grandchildren of the generation that started the effort who are benefitting. They say that democratic governments can't stick to something, and that government is ineffective. There are those of us who differ with this diagnosis.
It's true that our national expenditures for health care underemphasize primary care and overemphasize specialty care. But it isn't true that we are getting nothing for our money. Herb's son Bob, my close friend, had severe heart attacks ten years ago, received heroic care including several days of hypothermia, and is alive and very well today. If he had suffered from his heart disease at the time of his father's illness, he would not be alive and well today. The progress has been immense. See his great book, I Will Keep You Alive, available from author.
Then there is what happened this week. On Sunday, my next door neighbor for over thirty years, David Levine, law professor at UC College of Law in San Francisco, came over to show me the documents from his cardiac stress test. He had had some discomfort at the beginning of December and had made the good decision to see his new primary care doctor. She was suspicious of something being quite right with his heart and ordered cardiac stress testing. The stress test revealed an abnormality with the S-T segment of the EKG and she ordered a cardiac angiogram to be performed the following Thursday. I looked at the report and explained some of the terms and findings with David. Doctor's don't have the time and the relationships with patients to do an adequate job with explaining, and it takes repetition anyway, so having a doctor friend next door is a good thing. My Dad always said, each generation of a family should have a doctor, to protect the family from all the crap that can go on medically.
I reassured David that what they were going to do was not dangerous, and in fact was to be welcomed. He was nervous and I told him that of course he will be nervous, but that I wasn't, because it would be routine. What we always want to be is “another one of that;” never “something interesting.” Yesterday he took Lyft to be at the hospital at 5 AM to be the first case of the day. At 7:45 AM I took his wife Joanna out to the hospital to sit and wait for him; another friend came a couple of hours later to sit with her and to take him home after I left. The procedure found a right anterior descending coronary artery 90% blocked in two adjacent spots, and the interventional cardiologist inserted stents that took the arteries from 90% blocked to 0% blocked. He told David that he was surprised to find the arteries so compromised, and the odds were that within a couple of months David would have had a heart attack. David was given waking sedation for the 90 minute procedure and could watch the image of the operation on a monitor if he craned his neck. It was all done through a small incision in his right wrist that took the catheter up the radial artery to the heart. David was just here today, just over 24 hours after the procedure, to tell me about it.
Ladies and gentlemen, this is Star Trek medicine. Who'd a thunk it? How is this possible? From premature deaths with little or no warning, to early detection and preventive procedures and a smiling man with no residua who will be fine.
In the midst of valid medical discontent, it's helpful to have some perspective.
Budd Shenkin
