The Operation

Last December Jane and I moved west from Massachusetts to Long Beach, California. We wanted to come out here to be close to our sons, both of whom have settled in the Golden State, Gardy in Los Angeles, Sam in San Francisco.  As any old guy who moves to a new state knows, one of the first tasks after establishing residency is to obtain a new primary care physician.

As a diabetic, I couldn’t put it off for long; I needed to get prescriptions for my Metformin, Glyburide, and so on. So I went doc hunting, and was able to bag Dr. Greta Wanyik, a long-time internist.  She proceeded to put me in touch with a cardiologist, a urologist, an oncologist, a podiatrist, and a dentist.  My bases were covered.  She also ran my blood, full scans.  It’s not like I hadn’t kept on top of my health, which – except for the diabetes – seemed pretty good.  My last blood scan had been run in October and things were mostly okay.

But then.  A surprise here in California was my PSA reading, which is a prostate marker.  It had been around 4.0, which is okay.  But now it had jumped to 6.5, a significant increase after a mere four months.  Not a good sign.  Dr. Wanyik sent me straight off to the urologist, Dr. Albert Petrossian, a young, articulate, thoughtful man.  I liked him at once, even though the various tests he ran on me fell well short of fun.

The results indicated prostate cancer, early stages, but undeniable.  This is every male’s most popular cancer diagnosis: nearly everyone gets it sooner or later, but it’s often slow-acting and treatable as long as it is caught early, before it busts out of the prostate itself.  Every year more than a million men are diagnosed with it.  I have many friends who have had it and who are still dancing on top of the sod, so to speak.

For the uninformed, and really until recently I was one of those uninformed, the prostate is a gland the size of a walnut, though saddle-shaped, hanging out just under the bladder.  The urethra, a small but important river, runs through it, carrying urine and seminal fluid to the outside world.  The prostate’s job is to make some of the seminal fluid. The gland is not supposed to grow; however, mine had defiantly enlarged, having become somewhat larger than a walnut, though not to the size of a watermelon or anything like.  Still, it was too big.  Dr. Petrossian performed a biopsy by sticking a greased pole up my butt; there were twelve clicks that sounded like a stapler, and the pole was gently extracted.  IT DIDN’T HURT.  Felt weird, but pain free.

When the results came in, three of my twelve staple sites showed cancerous material.  It was time to talk some turkey.

There are treatment options.  One is to do nothing, since many cases of prostate cancer progress at turtle-like speed. My father was diagnosed with it at 78, and he told me, “It’s a disease that I’ll have until I die of something else.” He was right, too.  Lung cancer, from early smoking and from working with asbestos as a civil engineer, got him five months before he was to turn 80. Partly because my PSA number had jumped so suddenly, I thought that my turtle was moving like a teenage mutant – too fast.  Waiting seemed a bad idea.

A second possibility is radiation.  Targeting the cancer used to involve some guess-work, but apparently nowadays the science has gotten much more precise.  There would be less recovery time than post-surgery would require. Hmm, I thought.  That sounds good.  And if it didn’t work, I could go for the knife.

The third option is surgery.  Cut the traitorous organ out.  The success rate for a surgical procedure is good; for my case, I was told the odds were 99%.  That would make a profitable trip to Vegas.  And I learned one more thing:  after radiation, the possibility of surgery coming in to repair a failure was significantly lower.  Apparently, radiation inhibits the body’s subsequent ability to heal.  That sold me.  Cut away, I said.

So on August 7 at 5:30 AM Jane drove me to Long Beach Memorial Hospital for the operation.  I had had three pre-op scans performed – blood, chest x-ray, and electrocardiogram. All these pointed to my fitness for the event.  At 7:30, with an IV in my arm, dressed in a glamorous johnny equipped with special warming vents, I was anesthetized into the nowhere that we go when everything is turned off.  Then a number of indignities were performed upon me.  I have since learned that my legs were elevated over my head and six incisions were made into my abdomen in order for the laparoscopic instruments to poke inside and do their stuff.  The capsule that contains the prostate was drawn aside – it is important to retain it to preserve various functions – and the organ was carefully removed along with all the cancer, leaving the “water channel” (urethra) intact.  Then the incisions were closed with a kind of super glue (and one suture).  Apparently the whole operation took between four and five hours. I couldn’t possibly say.

When I first awoke, Jane and Dr. Petrossian were there to greet me and tell me that I was fine.  I believe that they did this; however, I have absolutely no memory of anything until I later awoke in a hospital room.  A catheter had magically appeared in my penis (which I had no desire to look at).  A urine bag hung off the end of the bed. The IV was still attached to my arm. Every couple of hours a nurse would come in and take my temperature and blood pressure.  My temp ran a little warm for a while, but eventually settled down.

I cannot heap enough praise on the people who cared for me.  They were all kind, knowledgeable, professional.  I liked all of them.  The hospital itself was clean and well-organized.  However, it’s time to lodge my one complaint:  the food was dreadful.  Especially as a diabetic, most of what came up from the kitchen tasted crummy.  How could beef broth taste so foul?  The only things I could eat from the tray was sugarless jello and smoothies.  The rest went back downstairs.  One interesting side effect was temperature; when I took my first slug of hot broth, the pain in my stomach was excruciating, down I suspect where it met the stomach stitches.  I quickly drank some ice water and the pain abated.  Nothing else during the entire experience hurt as much as that hot broth.

In order to go home, I had to demonstrate bowel proficiency.  “At least pass some gas,” Dr. Petrossian said, “and a bowel movement would be a good idea as well.”  This talent has been the most trying for all my recovery, and even now, four weeks later, it still presents a challenge.  Getting better, though.

After four days in Long Beach Memorial, I went home, and Jane arranged to have a “vacation” to be with me.  For the first week I continued my intimate relationship with the catheter, sleeping with it, walking it around, even showering with it.  Then, joy of joys, it came out – not an experience I’d eagerly repeat, but such a pleasure once it was gone.  And then there was the process of learning how to control urination: Kegels.  Ah, yes.  I practice them often, even now.  When the prostate is removed, the sphincter that controls urination needs re-education, and Kegels are the educatory exercises.  I’m not going to provide instruction here, but they are not difficult and not painful, just necessary.  Eventually, I understand that control returns.

So here I am in Long Beach, cancer- and prostate-free, Kegeling away, moving slowly toward the light.  I’ll know more in time.  Six months to a year – or more – will bring me back to the whole me, or at least the most whole me remaining.  I have so many friends who are on the other side of this experience.  Bless them all.  Bless me, too.