MLB agent fights for his clients -- and his life

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By JOE LEMIRE

The lobby of the winter meetings draws a collection of baseball's finest talkers and rumormongers, with the long days testing each's stamina for conversation. Even in that room - amidst all the half-truths and full speculations - there are few who can keep pace of Josh Kusnick's motormouth.

The 32-year-old baseball agent - who represents star Indians outfielder Michael Brantley, Brewers reliever Jeremy Jeffress and Orioles catcher Steve Clevenger - will often have "just one more thing" to say a half-dozen times per phone conversation. "That man loves to talk," another client, free-agent reliever David Herndon, says with a knowing chuckle. Kusnick's cell number appearing in one's caller ID is an invitation to a half-hour time commitment. Kusnick himself has been known to differentiate between "five minutes" and "a Josh Kusnick five minutes."

Kusnick calls the winter meetings his World Series. Of the scores of reporters, executives and job seekers who crossed his wake last month in San Diego, however, few knew that he also busy grappling with his own mortality - delaying a potentially life-threatening surgery until after the meetings because, he says, "I would have viewed it as horribly selfish if I put my health before [my clients]."

The signs were few and subtle. When up chatting in the lobby until 3 a.m., for instance, Kusnick shifted his messenger bag over his stomach to hide where his surgically constructed bladder and stoma were leaking. To conceal the seepage, he wore dark clothing - though it was already in character for a grunge-music lover who idolized Kurt Cobain. I later learned that he keeps a spare change of clothes with him wherever he goes, often slipping a towel under his shirt.

Kusnick is not a tall man to begin with at 5-foot-7, but he walks with a nearly imperceptible hunch that claims a fraction of an inch. That was the result of one of his 42 surgeries, when the skin over his abdomen had to be pulled tight after a surgical opening.

All of this to repair a pediatric birth defect called bladder exstrophy, a malformation of the bladder whereby it is turned inside out and exposed on the body's exterior. Kusnick had his first major surgery soon after birth and has since endured three major bladder revision operations at the ages of 8, 12 and 17. His bladder is constructed out of his intestine and connects to stoma in his belly button, where he catheterizes himself.

"Fortunately, I live in a time where they can fix this," Kusnick says, "and I can live a relatively normal life."

Only after the winter meetings did he learn that there was another option to serious and invasive surgery: a less invasive procedure to repair the stoma that will stay clear of his fragile intestines, which have ruptured before. He'll undergo this procedure - his 43rd - at Johns Hopkins on Wednesday.

"The risk of complication is still really high," he says. "I don't want to get too high or happy on this. I'm not out of the woods [but] I feel like I've had a stay of execution."

Should the operation fail, then he still needs the more risky operation. A "something -otomy," he quips. Kusnick says he has endured the chronic pain, the periodic surgeries and the long hospital stays by maintaining a matter-of-fact mantra:

"Everything becomes a memory, and then you die."

Back in March 2012, the Mariners released reliever Philippe Valiquette, a 25-year-old lefthander with a 100 mile-per-hour fastball. He was two years removed from appearing in the Futures Game, but injuries and control problems had been recurring struggles. When interested teams contacted his agent, there wasn't much talk about years or dollars, just a matter of which frills-free minor league contract he'd sign.

Nothing would have distinguished this blip of a late spring-training transaction except that the man negotiating the deal for Valiquette was sitting in a hospital bed. "Nobody knew where I was," Kusnick says.

Kusnick refuses to let his health be an impediment to his work and to his life. During his periodic hospital stays, he usually just checks in with clients via text message or confirms equipment orders for them. But with Valiquette in need, he set up shop with two cell phones, a laptop and an iPad cluttering his hospital bed.

"Even when he's in the hospital for weeks at a time, he'll always text me and say 'Good job' or 'Call me if you need anything, I'm still here and still working,'" says Brantley, a client since the minor leagues and one of Kusnick's groomsmen at his wedding. "That's from the hospital bed. That's dedication."

Baseball has always been a priority, long before Kusnick put the winter meetings ahead of his health. When he had a sports talk show on Sirius radio in 2010, he even did one show from his hospital bed. "He lives through baseball," his wife, Melissa Kusnick, says.

He grew up collecting baseball cards and autographs, writing to retired players and scouring minor league parks for up-and-comers. In fact, he made his first contact in the game, White Sox pro scout Joe Butler, while attending a Florida State League game in order to get autographs from future Marlins Miguel Cabrera, Dontrelle Willis and Josh Willingham. Butler taught him a few pointers. They've kept in touch, and Butler can tell that Kusnick retained his early scouting lessons.

"He knows what he's looking at," Butler says.

Kusnick began representing players while an undergrad at Florida State, even representing a big leaguer, former Marlins reliever Carlos Martinez, while still in school.

Murray Cook, a former general manager of the Yankees, Expos and Reds in the 1980s who has worked in scouting since the '90s, has become one of Kusnick's closest confidantes in the sport.

"I think the big thing is that a lot of baseball people and a lot of scouts think Josh is very outspoken and brash and has all the answers, and I don't see it that way," Cook says. "I see him as one of the good guys, who is honest and doesn't sugarcoat things with his players. I find that refreshing."

Cook is one of the few baseball executives who has grown close enough to Kusnick that he has learned of his medical condition. "Every time I hear from him, he's either in the hospital or [just] out of the hospital," Cook said. "He's lucky to be alive, obviously."

After so many visits, finding a vein for an IV is a challenge, with doctors recently resorting to the palm of Kusnick's hand, his ankle and his neck, among other creative locations. One client good-naturedly calls him "Bubble Boy." Kusnick has become Facebook friends with several of the nurses whom he has seen so often.

When Herndon was facing Tommy John surgery, Kusnick was the perfect person to assuage his fears.

"I had never had surgery before," Herndon says. "I was nervous about being knocked out. I want to say Josh has had 42 surgeries or something ridiculous like that. He just told me, 'Man, calm down, I've gone through it 42 times.'"

Kusnick alternates crass evaluations and a caustic wit with wisdom-tinged perspective. He shares some of that through articles he writes for Baseball Prospectus - his piece a month ago that denounced teenaged "Transaction Monkeys" trying to crack the media business in all the wrong ways garnered significant notoriety in baseball circles.

His non-baseball observations emerge in his amateur stand-up comedy act or in his gallows humor about his health. Finding levity in everything is his coping mechanism.

"It was always to deflect from being the sick kid," he says.

Kusnick wore a diaper or a pad until he was eight, at which point he received a catheter, but he made sure his friends and classmates never knew. He feared being the subject of "Josh is different" conversations, so he hid his condition. He went to lavatory stalls for privacy. He wore undershirts to hide surgical scars.

"Kids don't understand," he says. "So I never told anybody. I lied to everyone my whole life. People knew I had surgeries, but no one knew what was wrong with me - ever. I didn't want attention because of it."

Then and now, he has to catheterize himself every four hours for fear his intestine-lined bladder will burst. His mother worked at his elementary school until Kusnick was in fourth grade, which helped, but he also learned responsibility very young.
One day as a high school junior in early 2000, Kusnick couldn't catheterize himself. His stoma conduit had collapsed, prompting trips first to the emergency room in Coral Springs, and then at Johns Hopkins in Baltimore. There, Dr. John Gearhart, the director of pediatric urology at Hopkins, and another surgical colleague operated on him for roughly 10 hours in a major bladder revision.

Soon after his discharge, Kusnick felt a searing pain in his stomach and returned to the E.R., where he was diagnosed with a rupture of his intestine.

"It's the most excruciating thing in the world," he says.

For a while, Kusnick says, he had a hand-sized divot in his stomach where they repaired his intestine. In all, he was hospitalized for the better part of seven months and couldn't eat or drink on his own. He had a central line IV and a feeding tube.

"It was the craziest freakin' experience of my entire life," he says. "I never got hungry, I never got thirsty, but I still didn't eat."

With time, the new fistula eventually healed itself, and Kusnick left the hospital again.

"The lesson is that it's a major birth defect," Dr. Gearhart says, "and it is a lifelong birth defect."

Bladder exstrophy affects about 1 in 40,000 births. Hopkins sees more BE patients than any other hospital in the world and has been a leader in improvements in care. The defect can now be repaired better than it was when Kusnick was born, meaning the patients are typically stronger and can be more active.

"If they're continent of urine and their kidneys are normal, they can have a pretty darn normal life," Gearhart says. He adds, "The early years [Josh] got through it by a combination of tough self-will on his own to get better, and I also think he had good parent support, too."

"[Parents] tend to look on their children as relatively fragile when, in fact, they are not relatively fragile," says Dr. William Reiner, a pediatric urologist and child and adolescent psychiatrist at the University of Oklahoma Health Sciences Center, who also has treated Kusnick. "It might be a bad idea for them to play tackle football, but they can do pretty much anything else they want from a physical standpoint."

Kusnick was a hockey goaltender throughout high school and for a while had designs on playing at the club level in college.

"I just about bit my tongue when Josh said, 'Oh, by the way, I'm playing fairly high-level hockey,'" Gearhart says. "I think that says something about his spirit."

Though he missed the second half of his junior year at American Heritage High, Kusnick said he was able to make up the course work with the tireless help of his teachers and rejoined his classmates as a senior. He even returned to the ice. In his first hockey practice that season, the very first shot he faced somehow went under his pads for a direct hit against his flesh, a rude reminder of the chances he was taking by playing.

It wasn't so easy to impose normalcy on other facets of his life. After matriculating to Florida State, dating became problematic. Though males with exstrophy often have normal sexual function, intimacy required some degree of explanation.

"I sabotaged so many relationships in college with good people because I didn't want to tell them about it," Kusnick says. "The psychological problems of this condition are worse than the physical."

One girl begged Kusnick to tell her what was wrong. "I wouldn't," he says. "I just left."

Three years ago, however, Kusnick connected with an insurance agent on eHarmony named Melissa. At first they spoke on the phone while Kusnick was visiting his clients during spring training. Those conversations grew into eight-hour marathons. A date to a comedy club soon followed. By the fourth date, he had explained his whole medical history. Ten months after meeting, the pair married in Jan. 2013.

"That's just part of loving him," Melissa Kusnick says. "He pushes through, which is one of the things I really admire about him."

In addition to the stoma's leakage, abdominal pain persists for Kusnick - possibly a recurring obstruction, an abscess or scar tissue in his intestine as a result of all the operations. Exploratory surgery is not an option - there's a risk of a full rupture - so for four years Kusnick has been prescribed Tramadol.

Kusnick says at one point he was prescribed to take four tablets four times per day. That's 16 pills per day; nearly 500 pills per month. His medication bottle was about as tall as a can of soda, though he has since weaned himself down to about eight pills per day, in part because this summer the DEA reclassified Tramadol as a Schedule IV narcotic. (That's on the lower end of the scale, but Kusnick is reticent to take narcotics). He has periodic ultrasounds of his kidneys and liver to make sure there's been no long-term damage.

Intermittently, and without obvious provocation, the pain will grow unbearable, and Kusnick will return to the hospital for an overnight stay, something he did a dozen times in 2012. Most years, it's half that often, and he recently went 18 months between visits until late September, when he checked in because an infection had developed in old surgical site.

"I haven't really seen it take a toll because he's so positive," Brantley says. "He stays so focused at his job. He doesn't let it wear him down."

What Kusnick has learned and wants to impart to others, however, is that most folks aren't as judgmental as he feared they'd be.

"It's remarkable how understanding people can be," he says.

Kusnick chose to reveal his condition now because so few others with bladder exstrophy have.

"Nobody talks about it," he says. "There's no face on it."

Kusnick has started helping with fundraising efforts and communicating with younger people who have the condition and with their parents. The Association for the Bladder Exstrophy Community has invited him to be on its board of directors.

"He has an incredible career, an incredible life, and it's what you make of it," Melissa Kusnick says. "If you feel sorry for yourself because you're ill, then that's what you're going to get in life."

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