Neil Simon’s Kidney Disease

Neil Simon was America's premier play and movie writer. His more than 30 plays and 30 movies won a Pulitzer Prize, three Oscars, three Tony awards, 17 Tony nominations and four Academy Award nominations. He once had four successful plays running at the same time on Broadway, and in 1983, he became the only living person to have a Broadway theater named after him. 

 

On August 26, 2018, Simon died at age 91 of pneumonia, probably caused by food aspirated into his lungs, which often occurs with dementia (brain damage), associated with immune suppression from the drugs given to him so he would not reject the kidney transplant he received 14 years before.  His kidneys had been destroyed by a genetic condition called polycystic kidney disease. 

 

He Wrote About What He Lived

He became America's greatest playwright by writing about his own experiences.  He was born in the Bronx in 1927 and grew up during the Great Depression of the 1930s.  His early upbringing and poverty had a marked effect on his own life, his many marriages and the characters he wrote about in his plays and movies.  His father was a garment salesman and his mother worked in a department store.  Their constant screaming and fighting and his father's frequent absences from their home hurt Simon greatly. Money was so tight that he and his brother often had to live with relatives so his parents could earn money by taking in boarders.  He was very shy in high school and spent much of his youth watching comedy acts in movie theaters.  He said that he became a comedy writer in an effort to block out his painful childhood. At age 15, he received his first writing paycheck for doing funny sketches for a department store party. To obtain money for college, he enlisted in the Army Air Force Reserve at New York University.  He was sent to Lowry Air Force Base in Colorado, where he wrote pieces primarily about sports. 

 

After college he worked as a mailroom clerk for two years and then his brother invited him to join him in writing radio and television scripts. In his late twenties, he was hired to write for the television comedies Your Show of Shows and The Phil Silvers Show. He wrote scripts with Carl Reiner, Howie Morris, Mel Brooks and Woody Allen.  In 1961, at age 34, his first Broadway play, Come Blow Your Horn with Frank Sinatra, ran for 678 performances.  This was followed by two smash hits, Barefoot in the Park (1963) and The Odd Couple (1965), which made him the most sought after playwright on Broadway. In his late fifties, he wrote plays about himself growing up in working-class New York neighborhoods: Brighton Beach Memoirs, Biloxi Blues and Broadway Bound.  

 

His Characters and His Marriages

He wrote mostly about himself and his neighbors and friends, so his characters were usually white middle-class Americans, mostly New Yorkers and Jewish, and his themes were strongly influenced by his painful childhood and his first marriage.  He wrote comedies about fading love that often causes separation, divorce and child custody battles.  In Lost in Yonkers, which won the Pulitzer Prize, he showed that marriages full of strife can deprive children of love that can damage them so much that they themselves end up with emotional disease and failed marriages.   However, he often tried to save his characters by having them end up reconciling and staying together.  He constantly preached monogamy as a means of stabilizing society and made infidelity a source of suffering.  

 

He himself was married five times, twice to the same woman. At age 26 he married dancer Joan Baim, and they were together until she died of bone cancer 20 years later. That same year he married actress Marsha Mason, and stayed with her for 10 years.  At age 60 he married actress Diane Lander, divorced her one year later, and at age 63 married her a second time for eight more years.  At age 72 he married actress Elaine Joyce, who carried him through his kidney transplant at age 76 and his later years of suffering from dementia.

 

Polycystic Kidney Disease

Polycystic Kidney Disease is primarily a genetic disorder in which normal kidney tissue is replaced by sacs of fluid. It affects more than 600,000 Americans and causes about 10 percent of all end-stage kidney disease that requires dialysis and often requires kidney transplants. Symptoms can include back or belly pain, high blood pressure, headaches, and bloody and excessive urination. There is no FDA-approved treatment, but calorie restriction and avoidance of obesity may slow the disease's progression (J Am Soc of Neph, Nov 4, 2015).

 

His Kidney Transplant

His wife, Elaine, said that he was already having kidney problems when she married him when he was 72, and that his disease progressed dramatically in the early years of their marriage. By age 75, his kidneys failed completely and he required dialysis.  He suffered from exhaustion, severe muscle cramps, nausea, vomiting and worst of all, memory loss. He was now unable to write clearly.  He was waiting for a donated kidney and matching donors are hard to find.  One day he mentioned his need for a kidney to his friend and publicist, Bill Evans.  In 1976, Simon had taken a chance when he hired Evans, who was just getting started as a publicist, and they continued working together up until 2006 on more than 20 plays. Simon recalled that he told Evans, "'I just need to get a kidney somewhere.' Evans replied, 'Well, I'll give you one.' 'You would?' 'Let me think about it,' and he called the next day and said he would."

 

Transplants and Dementia
Seventeen percent of people over 75 who receive kidney transplants develop dementia within 10 years, often because the immune-suppressing drugs that are used to prevent the body from rejecting the transplanted kidney can damage the brain (J Am Soc of Nephrology, December 15, 2016).  Those who develop dementia have a 43 percent chance of rejecting their kidneys within 10 years and almost a 90 percent chance of dying within 10 years. The average survival time for people diagnosed with dementia is about four and a half years.  After kidney transplantation, the most common causes of death are heart disease (36 percent), infection (24 percent) and brain death (12 percent), with smaller numbers from brain aneurism, brain hemorrhage or ischemic stroke (J Am Soc of Neph, June 1, 1995;5(12):2048-2056).