On the evening of Tuesday, November 4, 2008, about seven o'clock, as the electoral victory of Senator Obama was being announced, I was reading a short email from my physician, telling me that I possibly have prostate cancer. I had waited for the email all day. The previous day, I asked my doctor to tell me the results of a recent PSA test. This was the news. My PSA index had exploded over the previous year. It was still rising. It was way above the score at which Big HMO conventionally does biopsies. Three years earlier, after a long, slow rise in my PSA index, my urologist said, if it goes up again, "we need to do a biopsy". I remember his words exactly and his matter-of-fact and unyielding tone of voice. Shortly thereafter, unrelated to my prostate worries, I began a radical transformation of my medical care and lifestyle under alternative medicine, under the supervision of a naturopathic doctor. In the first year of this new regimen, my PSA score dropped by half, down to normal for my age. When my score began to rise, again, a year ago, I was half-confident that a strict enforcement of my alternative diet and exercise schedule would knock back the score again.
As the excitement of Obama's victory rose from the television broadcasts in the background, I sat at my desk with my laptop. My heart beat began to race and I could feel, simultaneously and contradictorily, my heart fall into a chill and my blood pressure rise. My wife came into the room. She avoids politics and cannot abide political news. She was not particularly interested in the election. She and I both knew that McCain would be defeated. She came to learn from me if the doctor had written to me. I told her. She staggered backward and slumped into a chair in front of the television. Color drained from her face. "I can only imagine what you are thinking," she said to me. Then she began to cry. We were only a year and a half beyond her breast cancer scare, a drawn-out ordeal through which every emotion from anger to despair ripped through us before it concluded with a clean bill of health. She embraced me. "I'll be there with you every step of the way."
Every step of the way turned out to be many steps. Big HMO took two weeks to schedule an appointment for me to see my urologist, to discuss my PSA test and my condition, and then I had to wait two weeks beyond that for the scheduled meeting. Despite many calls by me and by my referring GP, Big HMO is so overbooked that I could get to see him no sooner.
In the intervening month, the management of the HMO sent me three letters discussing my cancer diagnosis. They wasted no words. They had no sentiment of sympathy. They had, in the words of an old and famous British joke about British bureaucracy, all the efficiency of the Communist East German housing authority, but none of its sense of humor. They scheduled me for additional tests and a biopsy. They reassured me that my urologist would discuss the options for cancer treatment. Quote fact unquote. I called and rescheduled the surgical biopsy. I wasn't going to have the biopsy before I talked about the procedure with my urologist. During the four weeks I waited for my urology appointment, every moment that my spirits stopped falling and I began to deal with my possible cancer with philosophical detachment and some acceptance, a new letter arrived to pump up the sense of dread.
Probably against common sense, since I did not have enough knowledge to evaluate the information, I began to inform myself about prostate cancer by reading articles on the Internet. Prostate cancer, if mine had been detected in the early stages, would not be a death sentence; but it would be a sentence of the end of my sex life. Every time I thought about the possible side effects of radical prostate treatment, I could feel a chill of fear rip through my nervous system like a rusty can opener tearing open a can of frozen orange juice. Thinking about a rotor-rooter procedure made my penis shrink back inside my abdominal cavity for security. A surgical excision of my prostate gland made my anus seize up. The likelihood of impotence filled me with despair. I had enjoyed sex so much over my life, the anticipation of not being able to enjoy it blackened my future. It's better than being dead, my wife said. I agreed, but I seemed destined to a half-life.
I listened to my body. I tried to sense the condition of my prostate gland. How would cancer affect it? Could it give me clues to whether I did, indeed, have cancer. I counted how often I urinated, and when, and the quality of urination. Did my testicles ache? What would aching testicles have to do with the prostate, anyway? Nothing, but I worried. I kept a mental record of how tired I was each day. Was I weakening in my morning runs? Did I take a long time to recover? Did I take naps? The infrequent naps I took provoked additional worry. Did I awake refreshed? Were my muscles sore?
I knew that these hypochondriac worries were incipient panic, but I could not resist them. Three years earlier, my urologist had told me, "These are the ten symptoms of prostate cancer. One ... no symptom, two ... no symptom, three ... no symptom ... nine ... no symptom, ten, you have cancer." More words chiseled into my brain.
I'm not superstitious, but superstition gripped me. I thought, prostate cancer is going to be my disease. It's my fault. I've enjoyed sex so much--too much--that God will take my sex life away from me. When my wife went through her breast cancer scare, I had been irrationally confident that she did not have it. I had thought, breast cancer isn't her disease; something else will be. I knew that confidence was simply denial of the threat to her, but superstition does not listen to rationality. Now, my success in denying that she had breast cancer rebounded to me in fear that I would have prostate cancer. My wife is not superstitious, either, but she said, she was praying for me.
My wife was with me. We waited in the consultation room for the urologist. He did not remember me from my appointment three years ago. He seemed absolutely as I remembered him. Direct. Plain spoken. Completely clinical. He pulled up my computerized medical record on the screen of Big HMO's networked computer. He read it over. He turned to me. I don't think it's cancer, he said. Cancer doesn't ordinarily cause such a rapid rise in the PSA. When the nurse took my blood pressure just before the urologist came into the room, it was 179 over 90. Ooh, that's high, she said. Fear of white coats, my wife gamely joked. The nurse replied, reassuringly, we'll take it again after the consultation. Now, with the physician's words, I could feel my blood pressure drop. Free fall. I'm lucky I didn't pass out, right there in the chair. He prescribed a course of antibiotics. I was too relieved to ask why. But I realized that he suspected that my prostate was inflamed because of infection. How could my prostate get infected, I wondered silently? I was ordered to take another PSA test a month after the anti-biotic therapy.
For prostate inflammation, my naturopathic doctor, with whom I had an appointment the following day, prescribed a course of diathermy of the prostate. Heating it, he explained, would increase circulation and reduce the inflammation. When I had discussed with him my PSA results several weeks earlier, he said he was not alarmed. I said, great, I'm glad someone is not alarmed. Now I began to think his lack of alarm was reasonable. I had four treatment sessions. In the first treatment, the heat was strong enough that it produced a light "sunburn" on my butt. I said, hey, my ass is so hot! Well, I thought the idea was funny.
My followup PSA test result came back earlier this week. My PSA index was significantly down. That's good, the urologist said. Not probably cancer, after all, I realized. Just inflammation. I am in Monterey with my wife this week, accompanying her to her business conference. I have been running along the recreational trail that follows the coastline of the bay from the Presidio westward to the lighthouse at the headland of the peninsula. Yesterday, the day after hearing the goods news from my urologist, I was invigorated and lifted. I ran longer than ever, six miles, more intervals than ever, twenty-four. The weather, sunny and warm, is unusual for a coastal winter in northern California. Everyone is out, smiling. The cloudless blue sky, the relentless surf washing the rocky cliffs below the path, the incessant barking of the sea lions, the brown hills across the bay, all seem elemental and eternal.