Part two
By
Tim Baehr, editor of
Menletter
©
2004
Waiting
Sometime in December I was given the
surgery date: Thursday, January 22, at 7:30 a.m. I was to show up
for pre-op at 5:30.
Diagnosis: prostate cancer.
Procedure: radical prostatectomy, in which the surgeon will remove
the prostate gland, seminal vesicles, and lymph nodes while
dissecting (separating out) the vascular and nerve bundle (at least
on one side) that control erections. The incision will be through
the lower abdomen, about four to six inches long. The operation is
of some delicacy and should take about three hours. The prostate
forms a tunnel for the urethra. Once the prostate has been cut out,
the surgeon must reattach the urethra to the bladder with tiny,
water-tight stitches.
The aftermath will be a week or two
with a catheter draining the bladder while the urethra heals. After
the catheter comes out, there will probably be some urine leakage
(incontinence) for anywhere from a few weeks to two years. Depending
on the success of the nerve-sparing, erections should come back with
a little chemical boost from Viagra or one of its successors.
This is all the clinical stuff, and
I'm very familiar with it and the statistics surrounding it (5 to 30
percent chance of cancer recurring in five years, 2 percent chance
of permanent incontinence, and so on). I know all the technical
terms like biochemical failure (if the PSA number rises quickly over
a year), metastasis (spreading of cancer to other parts of the
body), and so on. My feeling about any of the statistics is that
they're not destiny; they're not even predictive. I am one man, one
being, waiting to see what part of the statistics I will fall into.
The holidays
Beyond the clinical stuff, I have to
get through the holidays. This Christmas and New Year's, my youngest
son, almost 18, is home from college, and my stepson, 25, is home on
a break from a consulting job in Indianapolis. My wife's Aunt Eva,
94, will be with us for the week after Christmas.
I seem to be OK with the waiting.
There are lots of things over the holidays to divert the mind:
putting up the tree and lighting it, decorating the house and tree,
wrapping presents, cooking, eating, listening to music. Under my
company's use-it-or-lose-it vacation policy, I've finagled time off
from December 24 through January 4.
The weeks don't exactly fly by, but
they flow, smoothly. The holidays are filled with warmth and
connectedness. I don't know how much of this has to do with my
impending surgery. Both boys have become more mature over the past
year. Eva has conquered her fear of traveling. Ann has gained some
perspective on balancing the desire for a "perfect" Christmas
against the reality that we simply can't do everything.
We celebrate my 60th birthday quietly
on the 29th, just family.
The only concrete hint of mortality
is the violent stomach bug that Max and I get on New Year's Eve. Max
spends the day in the bathroom, worshiping at the porcelain altar; I
spend it in bed, having already spent my insides and feeling weak. I
check in on Max every half hour or so.
Doubts
Max bounces back and is soon gadding
about with his friends again. I find the bug more of an insult and a
concern. One fear I have about the cancer and the surgery is that
they will leave me feeling old and weak. The stomach bug and the
birthday with its big round number give me a physical and
psychological taste of this. I pass the beginning days of the new
year feeling OK physically but mentally feeling somehow already
disabled. A certain sense of vitality is draining from me. I've
begun to anticipate the violence that is about to be done to my
body.
Doubts have wormed their way into me,
boring into my equanimity. What if the diagnosis is wrong? Under
what set of circumstances could the PSA tests, biopsy, and MRI be
mistaken? Am I really a borderline case that could be treated less
aggressively than by surgery? Could there be a conspiracy, or just
an eager surgeon's blindness, driving me toward the operating room?
Do the medical people really know what they're doing?
I read some more from the books on
prostate cancer, one from my doctor and one we ordered on-line. Bad
idea to read them at bedtime! For a couple nights, sleep becomes a
stranger.
Inside me I know that these doubts
are both irrational and natural. I review the facts to dispel them:
PSA numbers that were trending upward. A "free" PSA ratio that was
too low for comfort. Biopsy results that were rated "moderately
aggressive." An MRI that showed cancer spreading to the edge of the
prostate on one side.
Somewhere along the way to January
22, I realize that I am taking particular notice of -- and getting
pleasure from -- the normal functioning of my plumbing. Taking a
leak or waking up with a spontaneous erection are like visiting old
friends who are about to go off on sabbatical. We've had many good
times together. I hope we'll meet again.
Pre-Admission
On January 16, my wife and I visit
the pre-admission test service at Brigham and Women's hospital. The
extensive literature that the hospital sent me told me that the
appointment would last about three hours and would include blood
work, an interview with a nurse-practitioner, and a visit with an
anesthesiologist. Before going to the appointment, I had filled out
an extensive questionnaire on-line regarding my current medications,
smoking and drinking habits, other possible health problems, and
concerns about anesthesia. I was curious to find out if anyone would
have read my electronic submission before I arrived for my
appointment.
Total time at the service: five
hours. Total face-time with medical personnel: less than an hour. It
turns out that the staff was short-handed because of severe winter
weather; in addition, there were many unscheduled "emergent" cases
coming through.
We had been there about an hour
before I was called. A nurse took my pulse and blood pressure,
hooked me up to an EKG, and drew blood for blood tests. Back to the
waiting room. We half-watched soaps on the ubiquitous waiting-room
TV, talked with each other, read. Time crawled by.
Round two: long interview with a
nurse practitioner. Egad, she had actually read my on-line
questionnaire. She asked many of the same questions anyway, to
confirm. We talked about what the surgery would be like, how long I
would be in the hospital (about one or two days too few, thanks to
managed care), and so on. We explored room options: the
euphemistically named semi-private (two to a room is more like
"barely private"), a new urology floor with all singles, and the
Pavilion -- a special floor with hotel-like accommodations, a
concierge, gourmet food, high tea every afternoon, flat-screen cable
TV, Internet hookups, and even extra beds for family members. Some
of the Pavilion rooms can be connected into suites. We can imagine
this whole floor being cordoned off for occupancy by a VIP patient
and his or her bodyguards, press flaks, relatives, and so on. At
$250 a night (insurance won't cover it at all), the smallest of the
rooms is tempting. I'll probably be either in too much pain or too
gorked to appreciate it, but Ann and any other visitors will
certainly be more comfortable.
We put in a request for a single in
the urology floor. But apparently we'll be able to switch over to
the Pavilion at the last minute.
More waiting. Time drags. I ask the
desk clerk if maybe I've fallen off the list. By now, we've been
there about four hours.
Finally, I'm called for the last
time. The anesthesiologist is not the one who will be in the
operating room with me. Her job today is to do a rough screening to
be sure I can tip my head back far enough to get a breathing tube
in, check other aspects of my health to be sure I can tolerate
general anesthesia, and allay any fears.
I do have two concerns.
One concern is that there is
apparently less bleeding with a local anesthesia, making the surgery
easier. The anesthesiologist, who has worked with Dr. Steele,
assures me that she's never seen him using anything but general.
Also, this hospital has standardized on general; local anesthesia is
an option, but not common for this operation.
The other concern is that the
tracheal tube may scrape up the back of my throat, causing canker
sores (to which I've always been very susceptible). A severe case of
canker sores in my throat could seriously compromise my recovery. We
discuss options and agree that the tracheal tube will be lubricated
and inserted under guidance of fiber optics. The anesthesiologist
e-mails scheduling to make sure the fiber-optic equipment will be in
the operating room on the day of the surgery.
We're done, just in time to go home
and make dinner.
It's less than a week until the
surgery.
Tim Baehr, editor of
Menletter ©
2004
Used
with permission of the author.
