Tuesday, November 30, 2010

In The Beginning

In the beginning….

Well, that’s a longer story than I have either the inclination or time to set down. The fact of the matter is that time is something I may not have a lot of.

There is a biker gang holed up in my Prostate Gland and they’re raising hell even as I write. And like most bike gangs, they are seeking to spread their influence and gain more territory. They’re also a bunch of assholes.

To carry on with that analogy, like a bike gang, you really don’t hear that much from prostate cancer until it runs you down. Then it just gives you the finger and carries on.

I found out about the gang’s invasion about 2 months ago from a doctor named Neil Fleshner. He is a prostate specialist and in a few weeks, December 16th to be exact, he will don his surgical scrubs, wash his hands (hopefully) and try, with single-minded purpose, to remove the bike gang by force.
Neil seems like a nice enough guy and supposedly he’s one of the best. When they eventually sling my extricated gland down under the old microscope they will be able to tell, apparently, whether or not they managed to eradicate the entire gang. But as we know, it isn’t easy to get a gang out of the neighbourhood. They have drugs to sell and bikes to largely ignore.


Sorry in advance, O delicate reader, for what may be disturbing and squeam-inducing descriptives, but you asked for it. Well, maybe you didn’t but you’re reading this aren’t you? Besides, maybe this knowledge will be of some service to you guys out there that are wondering what this Prostate thing is all about.
Last summer I had a physical exam that was long overdue and I decided, with much prodding from my partner, Brooke, to get a prostate exam. Little did I know that when a grim-faced Dr.Waxman (the doctor to the stars) inserted his finger in my anus, that this would be the first of many digits and instruments that would find their way there.

Dr. Waxman was concerned. He had felt a swelling in the gland and thought that I should do something about it. What, I asked? And so he set me up with Dr. Fleshner. Fleshner, he felt, would get to the bottom of it all. (Sorry about that, but we have to keep the mood light, yes?)

An appointment was made for September 3rd ( a fair distance from the physical exam and this will give you an inkling as to just how busy the average Prostate doctor is, be warned) and I showed up for some blood tests and further finger work.

A young Asian\Canadian intern, who’s name escapes me as I was in a bit of a fuzz at the time, came into the small, cold cubicle in which I had been allowed to wait for an uncomfortable amount of time.

“Dr. Fleshner?” I asked.

“Oh no,” said the intern with a smile, “I’m just his assistant. Dr. Fleshner will be along later. Now, can you pull your pants down please?”

I wondered for a moment if this was something I should do given that just about anyone could have come in and said that. I decided that this probably wasn’t the time to start getting finicky so down the pants came. Up the finger went. (As a side note, it is amazing how quickly you become something of a connoisseur when it comes to finger-inserting techniques. My rapidly growing list of doctors are primarily rated by their relative insertion skills. I judge them mostly on comfort level, but also speed is definitely a criteria.)

Dr. Unknown finished his exam with a snap of his latex gloves (he now sits at number 2 on the F.I. scale) and with a serious tone said that he had felt an abnormal swelling on the left side of the prostate but no nodules. No nodules was a good thing I was led to understand and was meant, I suppose, to give me some good news along with the bad. Then off he went to meet the mysterious Dr. Fleshner.
Sometime (a long time, actually) later Dr. Fleshner entered along with Dr. Unknown and another young intern.

“Well,” said Fleshner, after a brief bit of small talk, “we’d better get you a biopsy… it’s a no-brainer, actually.”

My first thought was that I would prefer it if all my care-givers actually did use their brains. My second thought was, well, that puts an end to any hope I had that this exercise would be over any time soon. I imagined that I could hear the bike gang revving their engines even now.

About two weeks later I was back at Princess Margaret Hospital in the GU clinic on the fourth floor. This is a room in which I appear as a fresh-faced youth compared to the others there. Brooke is with me this time and she waits as they walk me off to the biopsy room. She is along not only for moral support but also because after whatever happens in the biopsy room happens,  I will neither be able to operate a car nor wish to.

Now in the little brochure they give you to prepare you for your biopsy, they show you the instrument (not to scale) that will be inserted. They describe it as “about the size of a finger”. Well, if your system of comparison is based on the men of the CFL, then I guess that description might be right. But only a three-hundred pound tackle would have fingers the size of the ultra-sound stick that they actually use.

What is going to happen is this. The Ultra-Sound stick with its ultra-sound camera will be journeying up-country until it finds the prostate. It will be wiggled around until it gets some good pictures for mapping and then a small, needle-like device will project into the gland and take anywhere from 2 to 15 samples. As it turns out, I will have 11 samples taken.

But first, there will be another digital exam. This is news to me as it doesn’t mention that in the guide book. I mention this to some nurse who says…

“Well, we’ll have to have a look at that, won’t we?”

I consider offering to edit the booklet for her but don’t have a chance as  (and again, I’m sorry, but panic has played havoc with my memory) a doctor enters, lays me down on my side and enters me with the stick. That doctor takes position 3 on the F.I. scale.

Now, I’m pretty tough when it comes to temporary discomfort, but I have to warn you that should you have this biopsy thing done to you, you probably won’t forget it anytime soon. Although, having said that, I have been informed that some guys don’t feel a thing. How that’s possible I can’t imagine. Maybe you’ll be the lucky one.

Each pinch of the biopsy needle is accompanied by a loud bang that I assume is some sort of hydraulic device nearby letting off pressure. The process is agonizingly slow and after about 4 or 5 pinches, I am ready to talk. I would willingly give Hitler the plans to the atom bomb if he’d just get that goddam hockey stick out of my ass. Inevitably you start counting down. As I was told initially that there would be 8 extractions, I am ever so grateful when my countdown gets to 1.


“Well, I think we’ll need to get 3 more,” says the good doctor. I renew my countdown. When it is finally, mercifully over, the doctor says, “you know, it wouldn’t have been so difficult if you’d have just held still. It made it more difficult for me.”

I open my mouth to tell him just how sorry I was that I had made his job more difficult that day, but no words come out and I start to get woozy. They take me to a lay down area and give me a Tylenol.  The good news is that this doctor can’t see any nodule either. No nodule news now.

After about 5 minutes, the new pain, pain that was probably there all the time but I was so relieved to get the stick out that it felt like heaven by comparison, begins. After a while they help me out to the waiting area and I sit down by Brooke. I can’t speak at this point and just sit there shaking and holding her hand. Brooke is teary and is looking at me like I probably look like I’m about to keel over. Apparently many men do this. Keel over, I mean.

Eventually, we slowly walk  the few blocks to the car. Brooke offers to go and get it but I can’t stand the thought of being alone there on the street. Parking is impossible around the Princess Margaret, so bear that in mind if you have to do any of this stuff. We get in the car and a few blocks later, I start to cry a bit. I don’t really know why, not because of the pain really. That wears off eventually, in about 4 or 5 hours.

Cut to October 15 back in the CU clinic.  I am now going to get the results of the  biopsy. I have decided to go this one alone and sit waiting my turn in the uncomfortable, grey chairs. I am getting more and more nervous as I wait. It was probably foolish not to bring Brooke along. She did offer.

Finally I hear my name called but it is to inform me that they can’t  find my results. A mix-up has happened it turns out and they have filed them wrongly. Eventually the missing results are recovered and I am again ushered into the consulting cubicle. Dr. Fleshner arrives, this time with a young man, a young woman and a nurse in tow. The young people are administrative and medical respectively. The five of us are crammed into the tiny room. The stragglers are standing with their backs to the wall. No body is meeting my eye. I don’t like the way this is going. The smell of motorcycle exhaust is heavy in the air.

“Well,” says Fleshner., “I’m afraid there is cancer in there. In three places.”

It’s amazing how you can feel so hot and cold at the same time. I’ve read about this but never really expected
to experience it. I am temporarily at a loss for words. Eventually I just say…

“Well damn.”

“Yes,” says Fleshner, “damn.”

He informs me that the cancer is not of the wildly expanding variety, but neither is it of the mild variety. It’s sort of like Satan’s Choice as opposed to the more aggressive Hell’s Angels.  He begins to run me through some of the options. Surgery, radiation etc.… (More on this later). He tells me to think about it and then let him know. I tell him how I have lost both of my parents to cancer and I just want this thing…

“The fuck out of there?” he says. The others shift uncomfortably.


We decide to operate.

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