Cancer testing, the tale continues

Peggy had a migraine and was exhausted when we left the urologist's office (see photo), so when we got home, I rubbed her back until she went to sleep, but as I was tiptoeing from the room, I broke a piece of pottery and had to rub her back a second time. She couldn’t return to sleep, so we talked about her fears of me having cancer—if I have cancer—and possibly dying. I like it when Peggy shares her fears, but she worries that they will scare me, although I don’t remember a time when this was so—I can anticipate problems as well as she can. I tend to focus on percentages, so the better they are, the less scared I am. Peggy is so afraid of cancer that this doesn’t work for her. Some other disease might be easier.

I’ve had two previous cancer scares, but Peggy is more afraid this time, maybe because it’s the first time that I too thought I might have cancer. In fact, I wouldn’t have had my last two biopsies if she hadn’t insisted. They were both big deal biopsies that just scared the shit out of me—especially the one where the neurologist cut through the front of my throat to get a piece of bone from the back of my neck. Those two times, I just knew I didn’t have cancer. Feelings don’t constitute proof, so I recognized that I still might have it, but my natural confidence was such that I couldn’t get beyond seeing cancer as a remote possibility not worth the risk of a biopsy.

The more I learn about doctors and hospitals and the bad things they can do to a person, the more I try to make sure their proposals are necessary. Of course, when a book, the Internet, or a government panel’s report (like the one this week), tells you that a PSA-based biopsy (a PSA is a blood test) puts you at greater risk of harm than of good, and your doctor (along with two different urological organizations) tells you the opposite, whom do you believe? I should think the government panel would at least be objective in interpreting the data, whereas the urologists have a financial incentive to be biased--note that I said "biased," not dishonest. It’s also true that a person just naturally tends to believe in what he does all day. For example, Peggy is a nurse, and if the government had also announced that some standard nursing procedure did more harm than good, I’ve no doubt but what the nurses would be as enraged as the urologists. It’s hard to admit to yourself that you’ve been hurting people for years while trying to help them. Yet, none of this necessarily means that the government is right and the urologists wrong, nor does it take away my own doctor's power to influence my decision making. If I trust a doctor, I will generally do what he says—I just might not do it right away.

I’ve grown accustomed to orthopedists and neurologists, but this was my first urologist. Peggy went with me to the doctor as she always does (I do the same for her). She usually sits in the corner and says little, but today she sat between the doctor and me and read from a list of questions she had prepared and had me type. My first observation was that the waiting room was filled with old men, some with their wives, and I felt like I had walked into my next new club—Old Fuckers Who Dribble. I had known for some time that age would bring increased pain (even children know that it brings increased disability), but I hadn’t considered the indignities of aging. Old people have the kind of problems that gross out young people who are themselves certain that they will never have them. I reflect upon the fact that these indignities come to everyone if they live long enough, and this enables me to better accept them. Then too, death seems so near at times that nothing much matters to me anymore other than the fact that I have to fight to stay alive because I don’t want to leave Peggy alone.

I was prepared to mistrust Doug because statistics go against me trusting any new doctor (which is why I cling to the ones I do trust). He also works in a clinic with lots of other urologists, and I expect large clinics to be impersonal, rigid, and take a one-size-fits-all approach. As it turned out, I’ve never had a better first impression of a doctor. Changing doctors is a pain in the butt, so this meant a lot to me. He said that my odds of having cancer are 25-35% and suggested that I either go ahead and have a biopsy or, if I’m on the fence about the biopsy (prostate biopsies are another big deal kind of biopsy), that I have a blood test called a “free PSA” and base my decision upon the results. I jumped at the PSA. I don’t need government reports to tell me that I live in a test-happy/surgery-happy society in which I don’t dare subject myself to risk without doing what I can to avoid it or at least mitigate it.

Peggy and I have long agreed that it would be better for me to have cancer than for her to have it because she's so terribly afraid of it. She also fears death more than I. Yet as I see it, the one who dies has things relatively easy because the survivor will have suffered with him or her until the end at which time the survivor will embark upon an an even worse period of suffering while alone. I’ve always had doubts that I would survive without Peggy, but I always thought she would pull it together without me. To my surprise, things right now are so hard for her that I’m unable to console her. Yet, I’ve seen her handle loss before, and she always pulled herself together, so I think it likely that she will get her sea legs under her this time too.

It’s interesting how unpredictable Peggy is to me even after 41 years. Of course, none of us really know how strong we will be until we’ve been tested, and that’s mostly hindsight. Each new bad situation is never quite what I expected. There’s always fear, pain, anger, despair, and so forth, but it’s never the same fear, pain, anger, and despair because no two situations are ever the same. I’m not the same either, but at least I’m tougher than I used to be. Now, I just try to sit quietly and watch it all go by. 33,000 Americans die of prostate cancer each year, and another one is diagnosed every two minutes. I think of each of those men as being all alone in his own movie theater, just as I am all alone in mine. It’s the human condition. We can never feel another person’s life from the inside, so we are forever separate.

I’ve already gone through so much that a little more isn’t likely to hurt me unless there’s some unfortunate medical outcome. With every new ailment, there are new and interesting things to learn, and the tests and surgeries are often quite interesting too once you get past the fact that you might bleed a lot, will probably be in pain, will be exposed to noxious substances, and might very well die. I have grown increasingly able to make the best decision I can and to let it go at that, although I’ve lost faith that everything will go right because it's usually the case that so many things can go wrong, that there’s a pretty good chance that one or more of them will go wrong.

I panicked when I realized what a crapshoot modern medicine is even when everyone performs at their peak, but I’ve gradually grown fatalistic. The worst part is when I’m having trouble deciding what to do. For now, I know. If the free PSA test comes back bad, I’ll have the biopsy. That’s as far as it makes sense to plan right now. Yet, it’s emotionally hard to stop studying, and the subject is interesting if wearisome.