I was and am grateful to the Canadians, whose 'socialized' medicine, along with Great Britain's, comes in for a routine drubbing by the press in this country. Their respective systems have problems, but they are fundamentally egalitarian and, at the level of basic care, very efficient. Moreover, according to the World health Organization's most recent report, Canada's overall system - in terms of responsiveness to the sick, fair financial contributions, and achieving good health - ranks seventh in the world, with the U.S. at fifteenth out of 191 countries. In terms of life expectancy, Canada is twelfth, America twenty-fourth. Though I wasn't even a Canadian citizen, I had a battery of nephrologists and urologists working tirelessly to improve my health. There was no humiliating means test to prove I was poor enough to deserve medical care, no peering into my bankbook to learn whether I could afford the next blood test. Before I left for New York a generous friend named John Calvin (his real name) handed me an American Express Gold Card as a gift, joking that I should return to 'civilization' if I couldn't get coverage south of the border. But no coverage was no joke. I would eventually use that card not to return to Canada, but to purchase medicines and pay for blood tests in America.

Studying at Columbia University provided a necessary distraction, as I'd hoped. At the journalism school, students are permitted to select a topic of their choice, research it to the hilt, and write about it. That year there really was no other beat for me but the kidney beat. Even when I was reporting on bilingual education in Brooklyn or on Santeria in Queens, I was thinking about blood values and what was happening to my body. I found myself in the curious position of writing about a disease and treatment that I was experiencing and anticipating. As I learned how kidney-born erythropoietin helps produce red blood cells, I became anemic, pale as a hungry vampire. As I read how kidneys produce active vitamin D, my X-rays showed porcelain bones limned in shadow, my body siphoning necessary calcium from them. And by the time I discovered that uremia, a term that describes the accumulation of metabolic waste in the blood, means 'urine in blood,' my saliva had a foul taste, my fingers tingled, my appetite dwindled, and my heart pounded as it compensated for its failing constituent.

One of the reasons I survived as long as I did without dialysis was the arsenal of medications I used to combat my symptoms. Just before my transplant, my kidney was working at three percent of its full function, but I was ingesting and injecting drugs that kept me afloat as they replaced hormones and displaced potentially heart-stopping potassium while my kidney sank. And for the initial five months I was at Columbia, I got my first taste of the pharmaceutical hustle so many ill Americans need to learn to survive under the current system.