The Cancer Diaries, Part 2

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There was an episode in the original Star Trek series called The Deadly Years in which Captain Kirk and some of his companions aged rapidly. At one point, the ship’s computer pegs Kirk’s age at between 60 and 72: he stumbles around clumsily, bent, shuffling, is forgetful, has anger issues on the edge of senility. He’s a caricature old man. Watching it recently, we laughed at the cartoonish portrayal of someone who could be a decade younger than we, yet behaved like he was much, much older.

But there I was, a few days after surgery, bent and shuffling like the over-played Kirk. Simple movements, basic acts of muscles, were painful enough to make my body behave slowly and cautiously. I was careful not to put pressure on or pull areas where cuts had been made, or staples held fragile fresh together. And the catheter – well, let’s save that for later.

A reader asked me about the first part why I wrote about something that was, for them, intensely personal and thus private. My response was that there’s no shame in having cancer, nor in discussing it. In fact, those cultural veils I mentioned in part 1 also obscure our conversations about cancer, especially those cancers that affect organs associated with sex or procreation. Prostate cancer is just one, and I believe we are better off discussing it than avoiding it.  As my muse, Montaigne, did, I often write about my personal experiences, so perhaps my own experiences may help someone facing these issues in future. But I digress.

I neglected to mention in part 1 that I had had two follow-up hospital tests out of town (both scheduled for the same day) in the weeks following my biopsy; one for bone density, the other a CAT scan. Both were intended to help the doctor determine the extent of the cancer. Had that little rebellion reached out and crossed over to other organs? Infiltrated my skeletal structure? Crossed my biological Rubicon? If so, the prognosis would be more complicated, as would the treatment.

These tests were painless, aside from a few small pinpricks for blood samples and the injection of material required for the scans. More time was spent waiting than testing, so I was fortunate to have brought a couple of books. As in the past, I sat in waiting rooms with other masked and gowned strangers, all avoiding eye contact. Separated from one another beyond comfortable earshot, we were not talking. A sad silence hangs over these rooms.

(Always bring a book or books if you go for tests anywhere. Reading helps distract the anxious monkey mind from dancing around in useless speculation.)

The tests themselves require large, slightly intimidating machines where one lies, motionless, while the hardware moves and groans. For all its Star-Trek-like machinery, it’s a dull process and I almost drifted off to sleep during one of the longer segments of inactivity (I kept wanting to ask the nurse to beam me up). The nurses and technicians were efficient and friendly in a distant way, but not chatty. Patients don’t really get to know what’s going on as well as I think we should.

In the end it was easy enough to endure everything, even the inevitable waiting. In pre-pandemic times, afterwards I would have found a coffee shop to sit and ponder the events I had just experienced. Instead, I drove home, alone, absently listening to the local classical music station on the radio.

I had to return to the urologist for a conversation about options and another prostate finger poke. This time he wanted to check to see if my prostate was moveable, which would indicate surgery was an option. That was somewhat painful, but he believed his finger wiggling indicated my prostate was not fully fixed, so he could operate. That was welcome for all the discomfort it took.

The hardest part was, again, waiting for the test results. I had already decided that, if I had the option, to go for surgery – a prostatectomy (or properly a retropubic radical prostatectomy) – rather than radiation, in large part because I didn’t think I’d be able to make the ten-week, five-days-a-week radiation schedule on my own, and would not have a driver for that, either. Plus, as I understood it, I could always have radiation after surgery, but not surgery after radiation. Radiation, too, was harder on the body and physically draining.

The options were not inspiring, and I wasn’t even sure if I really had a choice.  I might simply be faced with one path or death. To paraphrase Edgar Rice Burroughs from The Gods of Mars, I was between the wild thoat of certainty and the mad zitidar of fact, and could escape neither.

Frankly,  even if it was my first choice, surgery of any sort, but especially where an organ is removed, and its absence in the aftermath, was not comforting to contemplate. 

Let me digress here with a political comment: I am eternally grateful to be a Canadian, no more so than during this time. My medical care – tests, surgery, doctor’s appointments, biopsy, hospital stay – has so far cost only a few dollars (prescriptions, hospital parking fees and even gas to get there). The total is, so far, roughly $100. Had I been living in the USA, without private insurance, I simply could not have afforded any of this. Prostate surgery in the USA can cost as much as $135,000 USD, and that doesn’t include the other medical care, tests, and consultations I had. As an American (likely unable to access insurance because it was a “pre-existing” condition; the sly bar under which insurance complies slip to avoid their responsibilities), I would have had only a grim choice between bankruptcy and death. I expect would have died. Canadian universal medical care has saved my life. I will rail against and fight anyone who wants to privatize our system and move to a for-profit medical system. End of rant.

Several anxious days later after these tests, I received calls from both my family doctor and the urologist. It seemed my cancer was, from all appearances, still constrained to the prostate, which made surgery a viable option and recovery more likely. A bright spot in an otherwise dark time. Susan and I lifted a glass of wine to celebrate that night.

But I was only mildly less troubled or anxious the next day when I thought about it. A dark wood indeed was in front of me. As Dante wrote in Canto 1 of The Inferno,

Ah me! how hard a thing it is to say
What was this forest savage, rough, and stern,
Which in the very thought renews the fear.

The bone density and CAT scans illuminated some age-related arthritis, but nothing more serious (I could have told them about my arthritis any cold or rainy morning…). Still, the spread and aggressiveness of the cancer meant not only that no one would guarantee it would be entirely removed with surgery, but also that, to be more certain the surgeon had to “go wide” in the removal, taking nearby material to ensure nothing had migrated. That material, the doctor told me, included various nerves connected to the penis that operated the mechanisms of erection (saving them is called a nerve-sparing radical prostatectomy. I would be one, in Catullus’s words (poem 67), “…languidior tenera cui pendens sicula beta.”)

This essentially meant a significant part of my sex life would end after surgery and recovery. Sure, there are various temporary measures available that involve injections, but contemplating these dampened my interest as much as I suspected the nerve scraping would. This was difficult to accept because sex ties intimately into the concept of masculinity and self; besides which, it’s both fun and bonding, even after all these years of marriage. Sex is an integral part of what makes us human; it is our core biology. But there really wasn’t anyone to talk with about it.

It would, I tried to tell myself, be my chance to practice monk-like (or drone-like) abstinence and put those Stoic and Buddhist virtues I treasured into action. I would live off my fond memories of past fleshy encounters over the decades. “Farwell happy fields,” Milton wrote in Paradise Lost, “Where joy forever dwells; hail horrors, hail Infernal world…” Happy fields farewell, indeed.

(Note to self:  I tell myself I to intellectualize this, make it non-emotional; look to what is left, not what is lost. Become Spock-like in my positivity. Maybe it’s time to re-read Timothy Leary’s exploration of sexuality and intelligence in his book, The Delicious Grace of Moving One’s Hand.  Leary,  one of my cultural heroes, died of prostate cancer in 1996. And to read again Cicero’s (my favourite classical author) great essay On Aging (De Senectute) in which he writes about coping with the loss of physical passion in old age, and warns that there is, “no more fatal scourge than bodily pleasure, by which the passions in their eagerness for gratification are made reckless and are released from all restraint.” I  have these and other sources of intellectual consolation to refer to.)

Throughout this time, since the first PSA results and the approaching surgery, I’ve never once felt that this was something “bad” happening to me, that I was the victim. This has always been simply biology at work: natural, albeit unpleasant, forces that may or may not be resolved through medical services. Not being religious, supernatural forces do not colour my views. I am not being punished for my immoral, unredeemed life. I have no belief in an afterlife, either, no belief in everlasting reward or punishment, no immortality, no reincarnation. Death, for me, is simply the end. I don’t wish for it, but I don’t fear it. It just is. Memento more is whispered in my ear.

Preparation for surgery began the day before the actual event, when the hospital contacted me by phone to discuss the details and do more pandemic screening. That set off the preliminary packing frenzy, selecting books (four, plus Kindle, based on my expectation of being there three days), charging the phone, and making other preparations. It also started the inevitable mental gymnastics. Because major surgery is new to me, I was anxious and, yes, nervous. I updated my will.

Our final meal together was a quiet affair, much left unsaid. I couldn’t even have a final glass of wine that night. Afterwards, in bed, I lay awake for a long time. By this time tomorrow, I would be a changed man. Assuming, of course, everything went well. It’s hard to still the voice that whispers that despite the odds in your favour, you may not survive. Does everyone who faces surgery go through this?

The day of the cutting, I had to register at the hospital two hours early, which meant leaving home about 75 minutes before that. As I mentioned in Part 1, no visitors were allowed, so I left my beloved Susan in the hospital parking lot to drive home alone. I was aware that, should things go wrong, this might be the last time we see one another. I suspect she was equally aware of that, too.

I walked in alone. Well, walked to the end of the line, already a couple of dozen people long. Screening for COVID-19 is a slow, necessary process that took 20-25 minutes before I was even at the entrance. But I was alone, without even the comfort of my partner to give my hand a squeeze, let me know she was there for me. Comfort was an early victim of COVID-19.

From there I went to the registration office at the other end of the hospital, lugging my overnight bag, trying to stay distant from the other patients marking the same trip.  Paperwork to fill in and sign. I was a cog in the great wheel of medical care. I tried to explain my restricted, meatless-diet, but was told to tell it to someone further along the chain. I changed into a hospital gown and housecoat, the fashionable, faded attire of patients everywhere. Then, masked and gowned, I waited, and read. And waited.

There are more tests, weighing, measurements, blood taken, IV inserted and its wheeled pole to be pulled along,  pills taken, shuffling from waiting room to waiting room. A rather cheery and chatty nurse explained some of the procedures, helped me put on compression stockings to ward off blood clots. Then I waited some more. Read some more.

Eventually, my overnight bag was taken away, and I was left in the final waiting room to wait some more. Unfortunately, by this time I was wearing my reading glasses but without the comfort of a book, which means even the obligatory TV in the waiting room was merely a blur to my limited eyesight. I sat with my IV pole, alone. The IV pump made soft mechanical noises that I tried to match with the rhythm of a song in my head. Some 80s’ electropop song? Devo? My mind wandered.

The surgery was originally scheduled for just before noon, and expected to take nearly three hours, but time passed and I was still waiting an hour later. The anesthesiologist stopped by to explain what he would do (general, as opposed to spinal). The surgeon came by, apologized, said there was a computer issue being fixed. I waited some more.

Then, 90 minutes late, alone, bored, and restless, a nurse came in to tell me to bring my IV stand and follow her into the operating theatre. My time had come at last. I stood and tried to practice the deep breathing of walking meditation as I and my pole shuffled in her wake towards the door.

Next part: surgery and recovery.

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