YOU’RE NOT GOING TO BELIEVE THIS!

THURSDAY (still 8 hours to go) -- It was all going so well.

I had checked in without effort or delay, I’d been interviewed by interns, residents, nurses and physician assistants all without incident. I had my plastic bracelet installed on my wrist identifying my body. I had paid my $300 co-payment. The doctor had visited and said all was go. The operating room nurse had visited and said all was go. I had changed into the hospital’s dehumanizing open-front robe. And I was still psyched! Let’s get it on!

Then the monkey wrench made its entrance in the guise of the operating room anesthesiologist. The anesthesiologist said he would not let me go ahead with the operation because my cardiac clearance form wasn’t good enough for him. He said he wanted more tests. An echo-cardiogram and a stress test. I was floored. So were Marcia and Joan. So was Dr. F, the surgeon.

After about 10 minutes of shouting, disappointment and accusations, Dr. F intervened, called Dr. U, the cardiologist, and negotiated a deal. I was to go uptown to Dr. U’s office, have an echo-cardiogram, and if I passed, would come back Friday morning at 6 am and be first on Dr. F’s list of lap band procedures. The doctor even promised me I’d be discharged from the hospital that same night if I was okay.

Of course, I passed the test, e-mailed the results to the hospital and was placed at the head of the line.

The sad part is that I’m getting used to all this. I’m saving it all up for my next rant – about how I’ve discovered that the real villains of the U.S. medical system are in the front office. They hold jobs like the doctors’ secretaries, receptionists, insurance negotiators and telephone operators. I know I said the opposite was true earlier in this blog, but I’ve changed my mind. That’s right, I’ve changed my mind. Fuck you! Sue me!

p.s.: Let me know your front office horror stories.

Meanwhile, we’ll all do it all over again in a few hours. Wish me luck – again.

WOW, WHATTA DAY!

WEDNESDAY (12 hours to go) – I don’t want to go through another day like today. Looking back, I’m sure Marcia, the secret weapon, turned the tide. When the surgeon’s assistant called this afternoon, she said: “Marc, you really owe me one -- and you better tell your wife!”

With any luck, tomorrow will be nice and calm. I think I’ll sleep most of the day.

I want to thank those of you who called and wrote and e-mailed their best wishes. Thank you all.

I’m going to try to blog from the hospital tomorrow. See you then.

SUCCESS! APPROVED, WE GO TOMORROW!

***** BULLETIN ****

NEW YORK (AP) --- Eager lap-band surgery patient Marc Kalech announced Wednesday he has been approved for the procedure by his all-powerful insurance company.

A spokesperson for Kalech said the decision was handed down at 4:28 p.m. and the operation will take place sometime Thursday. The hospital, Tisch Hospital at the NYU Medical Center on the tony East Side of Manhattan, will release the time later in the day, the spokesperson said.

A spokesman for the surgeon confirmed the approval at 4:44 pm, but no one from the insurance company could immediately be reached for comment.

###

CLIFFHANGER (continued)

WEDNESDAY (who knows how long to go) -- here's an update:

3:45 pm -- I call insurance nurse. "Marc, I'm so glad you called," she says. "I forgot all about you." She then checks her computer and, finding no answer, gets up to check on the status of my life. "I'll call you back."

3:55 pm -- Nurse calls back. "It's with the medical director. They expect a decision by the end of the day, which means 5 or 5:30" How long will you be there? "Oh, I leave at about 4:15. Good luck!"

3:59 pm: I call the surgeon's office and tell then what I know and ask them what time I should arrive for surgery in the morning. "Oh. don't come in at all at this point," she says. "What we have to do now is to call the insurance compasy and tell them we need a decision right now. We have to tell them we need a decision now. We have to complete the OR schedule." She tells the other secretary to make the call.

WILL HE OR WON'T HE?

WEDNESDAY (1 Day to go?) -- Here's my day so far:

9:36 am -- The surgeons office called and said they didn't get any paperwork from Dr. K last night and so the operation would be rescheduled. I freaked and said it was their fault and i was being punished after being on a liquid diet for 2 weeks. They said there was nothing they could do. i said there had to be and suggested i call Dr. K and find out where the paperwork was

9:49 am -- I call Dr. K and leave a message on her cell and at her office.

9:52 am -- i can't believe this is really happening so I call in the nuclear option. I phone Marcia.

10:00 am -- Marcia calls back and says she has got Dr. K's office to find her and tell her of the problem.

10:02 am -- Dr. K calls me and says she's talked to the surgeon's office and everything is okay.

10:04 am -- I call Marcia and give her an update.

10:14 am --Marcia calls back and says she just spoke to Dr. K who said she had completed all the forms and has sent them to the surgeon.

10:16 am -- I call the surgeon's office. They say they haven't got everything yet and it's now too late, the operation would have to be rescheduled.

10:17 am -- I call Dr. K and tell her. But she says she got off the phone with the surgeon's office and they had got everything and were sending it to the surgeon's office.

10:35 am -- Dr. K calls and says not to worry, the surgery will go on as planned. "You're on the schedule," she says.

11:59 am -- Marcia calls to say she's done everything she could and she says we have to "stay aggressive and pull out all the stops on this."

1:15 pm -- I call the surgeon's office to find out what was going on. I leave a message.

1:37 pm -- I call the RN at the insurance company assigned to my case and bring her up to date. She calls up my file and sees someone is working on it "as we speak" and would speak to her and call me back.

1:43 pm -- The nurse calls back and says they're still waiting for another piece of information from Dr. K and then would have to run it by the chief of surgery for the insurance company. She promised to follow it closely but says "It's out of my hands."

1:46 pm -- I call Dr. K's secretary and tell her to tell the doctor the insurance company is looking for her.

1:52 pm -- Wrong number calls. Idiot!

2:07 pm -- Surgeon's office calls and says they just got off the phone with the insurance company and everything is in. They are all awaiting insurance approval.

2:15 pm -- I call Dr. K's office. "Never mind."

THE MONKEY WRENCH IS THROWN

The monkey wrench

TUESDAY (2 days to go) – Well, with 48 hours left on the clock, the whole thing threatens to come apart. At the last minute, a series of calls from the surgeon’s office revealed that they had never bothered to clear the operation with my insurance. They clumsily tried to put the blame on me but I lost it. “Time after time, as recently as two weeks ago just before I started on a liquid diet,” I said. “I asked you if the insurance was squared away and you said: ‘Yes, you’re ahead of the game.’ ”  

It occurred to me that I might have struggled through this stupid diet for nothing. I think my reasoning prevailed and we managed to set in motion the machinery needed to get it done. My doctors all responded like champs. But there’s only so many hours to go and the firewalls of a gigantic and unfeeling insurance company to breech. It’s going to take a Herculean effort on the part of a few overworked young ladies to get it done.

I’m down. I feel defeated by the system although I’ve played by all its rules for so long. I’m not sure what went wrong, but I know it wasn’t my fault. We’ll have to wait for tomorrow -- and it’s going to be a cliffhanger. Shit!

Waiting on the sideline is my secret weapon. Marcia is primed to go and chomping at the bit. But I don’t want to send her into action until I’m sure she’s needed and the people involved deserve to die. She takes no prisoners. But she’s to be considered a nuclear weapon and must be used with care. But if the time comes, I won’t hesitate to use her.

Speaking of those who deserve the wrath of God, someday I’ll tell you about Sirius Satellite Radio.

At this point I’m hoping against hope. I must tell you, the odds don’t look good.

NECESSITY, THE MOTHER OF INVENTION

MONDAY (3 days to go) – The steamed vegetable dish is still evolving but has already impressed Marcia and myself so that it will undoubtedly become a steady part of our low-calorie diet when I can eat solid food again.

It’s getting to be crunch time now, but, if anything, I feel less pressure and I’m more resolved than ever to go through with the op and lose weight. My weigh-in this morning was down another 8 pounds. I was real good all day – let’s see what I weigh tomorrow morning.

MEMORIAL DAY WEEKEND

SUNDAY (4 Days to go) – I’ve just finished watching HBO’s “Recount.” It’s a great piece of work. It’s amazing what that production company can produce. I can’t help thinking about the “Hail to the Thief” sign my father stuck up in several places after the election and Marcia mentioned in her great TV eulogy.

Otherwise, it’s another day of diet shakes and steamed vegetables. It seems to be especially tough on the weekends when you a can about it. But I got a break yesterday when we went out to dinner with Norman and Elaine Lison. We went to a Turkish place in Roslyn with the especially exotic name “Chicken Kabob.” Always great food despite minuscule prices.

You might ask: “Why would I go to a restaurant on this diet.” I don’t know the answer and when I sat down, I felt like a masochist. But I had an unsweetened iced tea, a small cup of lemon chicken soup, a tiny piece of crisp pita bread and a medium sized Greek salad with no dressing and just a sprinkle of feta cheese. Between the food, jokes, conversation and company, I had a great time and left full. It made Saturday easy.

With only few days to go now, I beginning to obsess over details, like in what order I’ll be rolled into the operating room on Thursday. Originally, I was to be first unless there was someone with allergies scheduled later in the day but I had to change the date at the doctor’s request a month ago. I won’t know until Wednesday afternoon when they call me with the time I am supposed to report to the hospital. I’ll be happy if that’s all I have to worry about. I’ve really tried to do everything I can to get ready for this operation.

And yes, I do think Willie Randolph should be fired. Only an arrogant ex-Yankee would not intentionally walk a batter in that situation: tied game, bottom of the 13th, two out, runner on second with their best batter up. What bad could have happened, you idiot?

SNAG OVERCOME

FRIDAY (5 Days to go (eh, make that 6) Correction, 6 Days to go) – I’m certified. After running at least a half-dozen tests, Dr. U was enthusiastic about the idea. My blood pressure was 120/68! Not bad for a fat guy. I called Dr. K with the good news like a kid calling his parents with a good report card, something I never had the pleasure to do.

I gotta say that sticking to the all-liquid diet was the toughest today as it has been all week. It’s like three in the afternoon on Yom Kippur all the time. I’m hungry. Those four bottles of Ensure disappear a lot faster then I thought. There’s just no way they come close to filling you up. And the veggies just give your teeth something to do. They’re fun at first, but it quickly wears off.

I’m especially hungry in the morning, when I’m usually not hungry. Today I admit to giving into the dark side and having two pretzels behind closed doors in my office.

But I’ve been certified and I’m more psyched then ever. Next stop: The 6^th floor of NYU’s Tisch Hospital and the operating room.

A SNAG?

THURSDAY (6 days to go) -- It started as a real good day today. When I weighted myself this morning, I found that I lost another 6 pounds and I so I tried to fit into what used to be my favorite Zegna suit. It hasn’t fit in five years and three weeks ago when I tried to put it on, it wasn’t even close. But this morning it fit beautifully and I was comfortable all day.

I was hungry during lunchtime for the first time so for the first time I ate more than shakes for lunch. I ordered a small salad with lettuce, carrots, tomatoes and lots of cucumbers without dressing. Not only did it taste good, but it satisfied me. Everything seemed to be going well.

Not on the medical front. Dr. K called this afternoon and I completely expected her to say the rest of the tests and come back and she had certified me ready for surgery. But my confidence was shattered when her first words were “Don’t hate me, but…”

“Oh no!” I said.

She claimed she was just being over-protective but she would feel better about it if a cardiologist joined her in certifying me. With any other doctor I would be suspicious of his reasons. But I trust Dr. K and so I tried to make an appointment with my cardiologist, Dr. W, who saved my life 15 years ago and then saved my father’s six months later. Dr. W is on vacation until a day after the scheduled surgery but his partner, Dr. U, agreed to see me tomorrow morning – in 12 hours actually – after I explained what I need.

One last thing: When I got home this evening, my left foot, the one that is weeping, hurt like hell. I mean singles-like pain: Seven on a scale of 10. Nothing I did or took helped and it looked real raw – like of volcanic surface of Io. I was stumped and in agony. Then I got an idea that it might/must be an allergic reaction. Sounds crazy, I know, but 10 minutes after taking 30 mg of Benadryl it started getting better. And, starting at the top and moving down, it began to look better.

I don’t know, but I have a bad feeling about tomorrow. So I guess this ends as a cliffhanger. See you then.

A GOOD DAY

WEDNESDAY (8 days to go) -- My visit with Dr. K went well. I’m officially down a total of 44 pounds from my highest weight. She was appropriately pleased and said if I come close to my goal weight I will be able to stop taking insulin, probably stop taking all diabetes drugs and be able reduce many of my blood pressure drugs. I’m thinking that if I can get down to a dozen from the 2 dozen drugs that I take every day, then taking care of me might become a part-time job from the full-time career it is now. Already, I’ve had to reduce my insulin dose by 25 percent and it appears that it’s not enough.

I was tempted to raid the pretzel jar at work today but resisted. For dinner, I had Brussels sprouts, onions, red bell peppers, mushrooms and parsley steamed in water laced with salt, pepper, habanera pepper hot sauce and garlic. It seemed was really good. I think my taste buds are dying.

But the best part of the day was that four people actually and independently told me I looked thinner. And I was able to comfortably button and wear all day a pair of chinos that I have not been able to put on since 2003. Just one small downside: my best belt is on its last hole.

Stay tuned.

SO FAR, SO GOOD

TUESDAY (9 Days to go) -- Doctor K, my endocrinologist, primary care physician, general contractor for major medical problems and all-around guardian angel, called early this morning. Apparenly, the system sent her a request for medical clearance to go ahead with surgery and being one of the best representatives of this country’s medical establishment, she wanted to actually see me before the operation. I agreed to see her tomorrow afternoon (Dr. K is one of few medical doctors I’ve ever looked forward to visiting).

I have to remember to ask her how I’m going to take the 24 different drugs I take every day after the operation. We need to discuss which are mandatory to take during the two weeks when I’m not able to swallow anything solid.

I still can't believe I've gone five days now without eating anything solid. Basically, the only solid foods I’ve had since last Thursday afternoon’s pastrami on rye has been some low-calorie veggies and a few pretzels I ate in my office yesterday during a rare moment of weakness. This evening, for example, I had a cup and a half of raw carrots, broccoli, cauliflower and celery with a couple of tablespoons of “Green Mountain Gringo” roast garlic salsa. Except for being incredibly hungry, it hasn’t really been so bad.

But I think Dr. K will be happy with my weigh in tomorrow. (Noted: Dr. K is the only human I allow to weigh me on a regular basis.) I like to make her happy. When she’s happy, it means I’m getting better.

BACK TO THE HOSPITAL

MONDAY (10 days to go) – I spent most of this morning in the hospital being poked, probed and generally humiliated to see if I was healthy enough to be cut open and exposed. It’s not really the hospital employees that you come in contact with, it’s the system that scares you. In fact, when I got lost in the same basement labyrinth that I got lost in five years ago (see “The History of Medicine” below), a friendly young woman actually went out of her way to ask me if I needed directions. And the anesthesiologist, nurse, and X-ray technician who tested me were efficient, professional and reassuring. But it seemed like the system, maybe the actual building that held everything, was trying to frighten me -- and succeeding.

I’m having a hard time believing that I’m still true to the diet. A donut on the counter at home looks so delicious it’s hard to believe. Even the pretzels in my office at work that I ignored before the diet look like manna from heaven now. But I’m steadfast to 1000 calories a day – at least so far. I’m not eating to live. In 10 days I’m assured it will get easier.

One good sign: I weighed myself this morning and I’ve already lost 21 pounds in the first four days of this program. Not bad. Believe it or not, I’m running out of notches on my “fat belt.” It won’t be long before I have to go into my closet for the next level of clothes. I look at it this way: a midway goal is when I can again fit into my cashmere Zegna overcoat.

Another will be when I get up enough courage to tell you my actual weight. More later.

IT’S NOT EASY

SUNDAY NIGHT -- Eleven days to go.

Well, the weekend’s over and I've made it through 3½ days now without breaking the all-liquid diet. It’s been a lot easier because my darling wife has agreed to join me in this effort simply because she loves me (although she says it’s a matter of solidarity).

I’m allowed 2 cups of low-calorie veggies a day and I’ve discovered that a combination of steamed Brussels sprouts and onions makes a pretty good-tasting meal. Also, I’m allowed high protein drinks like Ensure or Opti-fast. A total of 1000 calories a day – that means 4 bottles of Ensure.

As bad as Ensure tastes by itself, I’ve discovered a combination of chocolate and vanilla mixed with ice in a shake tastes alright. But I really can’t imagine existing on this for another 4 weeks and I’m on the lookout for more recipes.

So far so good. I believe I’ve actually lost some weight and inches already. Tomorrow morning I’ll weigh myself and I’m scheduled for pre-surgery medical tests. Keep tuned, I’ll let you know how it goes.

THE RETURN OF THE BLOG

WE’RE BACK!

Dear friends: It’s been an eventful year, that’s for sure. But Marc’s about the start a new adventure and he thinks it might be worth writing about, even if it’s just for his own sanity. So watch this space for new hilarious misadventures and medical updates. Following the advice of just about all of his doctors, he’s going to try to lose weight. A lot of weight. Except this time he says he’s serious and he has convinced a doctor to operate on him. Here’s his first entry:

I’m going to lose 150 lbs. Really. No gambling please.

Just to get off to a fast start I began with a good lunch yesterday. It’s shown in the picture above. That’s an overstuffed pastrami sandwich from Katz’s Deli on the Lower East Side displayed on my desk before I made a meal of it. A bag of crisp, greasy french fries sits on the right and a big pile of half-sour and sour pickles with a couple of pickled tomatoes thrown in is above left. The sandwich is the classic New York pastrami on rye with mustard and cole slaw on the sandwich with a side of slaw because they NEVER put enough on the bread.

Katz’s (they still have signs that ask you to “Send A Salami To Your Boy In The Army”) has become more of a tourist attraction then a real deli in the past 20 years. Every 15 minutes another tour bus full of Germans or Midwesterners pull up and herd their clueless, grossed out passengers inside, where they order corned beef on white with mayo. Except now, the dazed, non-confrontational waitresses don’t even raise an eyebrow -- they just deliver the sandwich without comment. Every so often, a gaggle of overdressed girls from New Jersey or Long Island arrive and are disappointed that they can’t get waitress service at the table where Rob Reiner’s mother sat in “When Harry Met Sally.” A sign hangs over the table to save everyone’s time. (“I’ll have what she’s having.”)

I was immediately recognized as a knowledgeable food junkie because I ordered “soft pastrami” to insure I got enough fat. Only those who aren’t properly initiated order “extra lean.” A sign above the counterman advises that will cost ya an extra buck. But Myron the sandwich guy quickly sized me up as a real member of the club – especially when I reached up and slid a dollar bill across the glass counter. (The countermen at Katz’s stand above us mortals like pharmacists in an old drug store.) I swear there was a twinkle in his eye as he hand cut the sloppy piece of cow flesh and passed a flaky, moist translucent slice back to me for my approval. He did it with all the pride and professional flair as a tuxedoed waiter pouring a taste of fine wine at Jean George. The meat exploded with the proper firework display of tastes as it quickly melted on my tongue and I gave my approval to him with just a glance.

Back in my office, I stuffed myself until I thought I might become bulimic and solve my problem the hard way. But I didn’t and I will go ahead with the surgery. The sandwich was my last meal before the operation because for the next two weeks I’m on a strict liquid diet. It seems they need to shrink my liver to get it out of the way before they fuck around with my stomach, which for 60 years is used to getting crap like the sandwich from Katz’s and I’m sure it will try and punish me for denying it what it wants. It’s used to getting what it wants.

But in two weeks it’s not going to want it anymore.

I won’t bore you here with the gory details of the operation. It you’re sick enough to want to know more just check out “Adjustable Gastric Lap-Band Surgery” on the doctor’s web site. Just click here. Meanwhile, it’s four 8 ounce bottles a day of Ensure for me. Today was my first full day. Oh my God!

HELP!

Watch this space for more news.