Today marks the 5th anniversary of my being given my prostate cancer diagnosis, presuming one considers the date informed as the anniversary.  It was September 22, 2005 and came after about a month and a half following my going to my family doctor to get my ‘problem’ checked out.   It was a Thursday and in the satellite office of the urologist who did the biopsy.  Thinking about it, I suppose the office was appropriate for the news being delivered, for the entrance was on the back side of the building which was older and in which sunlight was scarce.  The doctor, I’ll call him Sam, was a modest sized and younger guy of Asian decent who seemed to have a somewhat pragmatic approach to delivering this type of news.

When I arrived at the office for the late afternoon appointment, I did the requisite checking in with the receptionist.  At this point there were no forms to fill out, I had already done so at the main office where I was originally seen.  Once checked in I was instructed to go to the adjacent waiting room until called.  I did so and while sitting down I sought out some reading material because since I had come directly from work I didn’t  bring any.  I suppose that given the reason I was there I should remember all kinds of details, the magazine I chose, the various articles and who was in the waiting room with me, but I don’t because I found nothing remarkable to remember.  The one thing I do remember is there was one other person in the room, albeit I don’t remember gender or any other defining characteristics.

In reading accounts of others who had biopsies and were waiting to receive the results, I supposed I should have felt some degree of anxiety, some degree of anticipation, but none of that was present.  I did feel annoyed, however,  because with the very few people in the office, and as seems to always be the case within the medical profession, I was waiting well past the scheduled appointment time.  If I recall correctly, my appointment was for 3:30 pm and it was around 4:00 pm when I was called to go in the examination room.  It was at this point I noticed that I was, as it seemed anyhow, the doctor’s last patient.

It was clear from the initial appointment with my family doctor that there was a substantive problem.  Most profoundly, I had lost my ejaculate, frequent urination had been surfacing for several months and the DRE revealed something abnormal.  They then took blood for a PSA which  turned out to be 30.1 and added to by the sense of urgency he exhibited in getting me in to see a urologist.  Interestingly, getting an appointment with the specialists in his own system involved a several month delay and although less so with Sam’s office, still, in his mind, the delaying was unacceptable.  So he employed a creative strategy, one I think only a more seasoned practitioner would think of, where he obtained an appointment for me with a nurse practitioner in Sam’s practice.  In doing so what he described would happen, did.

When I went to the nurse practitioner appointment, she went through the standard procedures.  First she took a history, asked about my symptoms and took a short history.  She then proceeded to perform the DRE and upon its completion, asked me to wait while she left the room.  She returned with Sam who followed up with some additional questions and then performed his own DRE.  Side note here, I’m guessing the practitioners get some degree of flack from patients when performing DREs because they seem quite sensitive to the ‘recipients’, each apologizing for performing the procedure before the exam itself.  Anyhow, following his exam, it was clear from his expression that Sam felt something serious was wrong.

The next step following the DRE was an ultrasound which is not unlike that done for pregnant women.  The technician came in, applied the ‘jelly’ and began the test.  Once finished she left the room and came back saying I needed to try to empty my bladder since its contents were obstructing ‘the view’.  I went to the bathroom as requested and did my best to relieve myself.  I wasn’t very successful but did manage to release a small volume.  Again the technician performed the scan and again she asked if I could try to empty further – it seems my bladder was nearly half full at this point.  Back to the bathroom where, after a substantive effort, I released a negligible volume.  The scan was performed again.

At this point Sam returned with the nurse practitioner and began revealing his thoughts.  He first laid out the background, what the tests indicated and to what they pointed.  Interestingly, he first mentioned BPH (benign prostate hyperplasia), moving quickly to his suspicions and possibility of cancer.  In his elaboration, he began building the case based on the diagnostics, nothing of which surprised me.  His sense of urgency then returned when he said he wanted to do a biopsy and soon.  While the idea of a biopsy didn’t surprise me per se, the alacrity with which he wanted to do it caught me of guard.  The current appointment was on a Tuesday and he proposed Thursday of the same week.

I agreed to the Thursday biopsy and appeared again as scheduled.  For those who aren’t familiar with how a prostate biopsy is done, here is a description.  The patient lies on their side in what amounts to the fetal position and the doctor, with assistance, first  does an ultrasound.  Once satisfied with the result, in my case we returned to the whole back and forth to the men’s room thing, they begin the procedure.  The procedure itself involves inserting a gun-like device through the anus and guided by ultrasound.  There is something like a point on the device which penetrates the colon wall and inserts into the prostate.  When taking the cores there is a mild ‘snap’ and with the procedure repeated for each core,  for a total of 12 cores – 6 from each lobe.  When finished someone, in my case Sam, explains that it is likely you will have blood in your stool and urine for perhaps several days.

I was also told the biopsy results would be returned in about two weeks.  When I checked out the person at the desk asked when I would like to return and in the process offered the satellite location since it was much closer to both where I worked and lived.  I made the appointment and the ‘wait’ began.

Since this happened I’ve met a number of men, or read accounts of,  others’ experience during the waiting time.  I suppose, unremarkably, it is not surprising that many become very anxious and concerned about the possible outcomes, after all, we are talking about ‘the big C’.  I suspect the anxiety is rooted in either the fear of dying, a real threat when talking about cancer, precipitated by a fear of the unknown frontier death presents or a sadness for giving up something loved – a love of life.  For me I’ve never really felt either – I’ve always kind of viewed life as a phase, a step in the progression of our being.  While I concede my attitude may change with the realization my death is eminent, for now I neither harbor a fear of death or an overwhelming love of life.  Ironically, I harbor a bit of a curiosity with death, which, in my view, is one of the few truly ‘final frontiers’.

My curiosity, if one would call it that, of death derives from my grounding in science.  We often read about people who “floated above their lifeless body” or who, when determined medically dead but ‘came back’, saw a bright light at the end of a tunnel.  I have often wondered about these things, indeed, what is the truth and how one could ‘test’ their truth.  The religious accept them as a matter of faith, the atheists, of which I see agnostics as a subset, simply dismiss the whole thing and seek some kind of scientific basis for the feelings experience – perhaps some sort of hallucination.  I could, and have to some degree already, write nearly a whole book on this subject and my thoughts about the premises for my beliefs.

Back to the appointment and the news, I’m not sure if my being his last patient was contrived, with the idea of leaving the delivery of this kind of news for the end of the day, or coincidence.  I really don’t think it contrived because I made the appointment before the results being available.  It was an interesting appointment, pretty simple, with Sam starting out with being somewhat tentative in his presentation – it seemed like he was being interviewed on television for the first time.  For me, I didn’t feel any real sense of anticipation, I pretty much knew what he was going to say.  My ‘expectation’ was not because I was being negative, I expected the worse, but rather a simple acknowledgement of the facts received to that point.

Sam began his delivery by outlining the already known, PSA levels, character of the prostate as determined by the DRE and the physical symptoms.  He further began to explain the pathology, principally the procedure of taking the 12 cores and then how the Gleason system worked.  Throughout this he would stop to ask if I had any questions, I didn’t, I had already educated myself.  He then became more specific by giving the number of positive cores, the Gleason and the latest PSA.  His conclusion, I had a case of very high risk prostate cancer which, by its very nature, aggressive and well entrenched, was very life threatening.  I smiled and, not sarcastically, said wonderful.

Happy reading and happy trails.

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