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Sunday, September 21, 2008

My Turn (on Douglas Messerli's operation for prostate cancer)

Patient Messerli, Douglas
Cedars-Sinai Medical Center

In July 2008, soon after completing an essay on the death, by prostate cancer, of my father (see June 15, 2008), my primary doctor, with the improbable name of Redcross, thought he detected a hardening of my prostate. After ordering a PSA (prostate specific antigen) test reading, first 3.5 and a couple of weeks later it was at 6.0, I was referred to a specialist, Dr. Jay Stein, who ordered a biopsy. On July 17 I was admitted to the Taper Imaging Center of Cedars-Sinai Hospital for a prostate biopsy. On July 24th Dr. Redcross reported that they had found cancer, but that it was a very early find in a very small area. “Radiation takes care of most of these occurrences today,” he reassured me. Obviously, given the experiences recounted above, I was disconcerted. But I took a positive attitude, knowing of the advances in curing the disease since my father’s death and believing—what else given the situation can one do—in the doctors’ prognoses. As Dr. Stein had observed on my earlier visit to him, given my family history—the death of my father and the discovery of prostate cancer in my uncle—there was a strong possibility that I would also get the disease.

My blood pressure continued to rise during this period, and Dr. Redcross prescribed yet another pill, Feditab, to help bring it down. I was also distressed to find out from another doctor that the two small growths on my penis were STP venereal. And, on top of all of this, I was terrified what another doctor, Dr. Olsen, might find in my upcoming esophagoscopy and colonoscopy. It was as if my entire body was conspiring against me. Certainly I had expected to encounter the results of my prodigal living, particularly my heavy drinking, at some point in old age, but now, at relatively early age of 61, everything seemed to be coming to haunt me at the same moment.

On July 27 and 28, Dr. Redcross ordered a urine test to see if he could determine any secondary cause for my spike in blood pressure. That test proved negative. Dr. Redcross again reassured me that my cancer was at its earliest stages and would be easily containable.

Meanwhile, I continued to write essays for the volumes of My Year and edit new titles for Green Integer, as well as prepare for teaching, which was to begin at the end of August. Finally, on July 30th, Howard and I met with Dr. Stein to discuss the findings of the biopsy. My cancer was evidently fairly high on the Gleason scale, meaning that it was an aggressive version of prostate cancer. Although he presented all my options, and suggested I consult a radiologist, he argued for complete removal of the prostate. He gave us several essays and suggested a book to read, and we were sent home with rather serious decisions to make in the next few days.

Although my father’s cancer had obviously not been resolved by the operation, the major problems he later suffered had been through lesions produced by the radiation, which resulted in profound bleeding. Howard and I both determined that, since the discovery of the cancer was early and the growth contained, the removal of the prostate would give me the best opportunity to curing the cancer.

I called my family and several friends—the Bernsteins, the Nakells, Paul Vangelisti (who agreed to replace me for one week of my classes), Thérèse Bachand, Deborah Meadows, the Antins, the Perloffs, and a few others. I determined to be upbeat in my attitude about the whole thing and to continue writing up to the very day of surgery, now scheduled for September 15th. Meanwhile, as for any such serious operation, I was scheduled for a whole new series of appointments: a bone scan (which ultimately proved negative), an X-ray to check a possible mark on my ribs, two sessions in which I stored my own blood for possible use in surgery, and a pre-operation checkup, which again involved a battery of blood tests and X-rays.

My colonoscopy on September 5th resulted in the removal of 14 polyps, all of which were benign, but meant that I would have to have another test in a year. My esophagoscopy showed that I had Barrett’s syndrome, a precancerous condition of the stomach—a condition, I discovered I shared with my brother. In short, I was just well-enough to sustain major surgery!

I did maintain an outwardly soldierly attitude, writing an essay and mailing a new book, North of Hell, to the printers the day before the operation. I told friends not to worry for me, that I was assured I would be readily “cured.” My doctor friend, Joe Perloff—who himself had undergone a more painful hip surgery replacement at a far more advanced age just weeks before—e-mailed me to reassure that I had made the right decision. Dr. Stein, by all accounts, was one of the best surgeons for this operation, and Cedars-Sinai, we all knew, was a superior hospital. Indeed, by this time we had encountered through Howard’s previous arm operation, my biopsy and bone scan, and other visits to the institution that the nurses were particularly attentive and friendly. Through a mix of institutional bureaucracy (“Name,” “Birthdate,” each nurse called out upon encountering you) and informative chit-chat, one quickly came to trust these efficient yet caring individuals. When my blood pressure was high before the biopsy, I am certain that the humor of one nurse helped to calm me, through laughter, just enough so that they could operate. Put under general anesthesia for the colonoscopy, I lost some of my fear of being anesthetized (when I was a child, I had a tonsillectomy, and was put under by ether; I had ether dreams for weeks after. This traumatizing experience was made worse by the fact that I also was circumcised, without my parents telling me beforehand, apparently too prudish to discuss any sexual organ of the body; I was 13.)

My nights, however, were not so determined by fortitude. I did not sleep well for weeks before the operation, and when I did sleep I dreamt various dreams of loss and being lost. My subconscious clearly comprehended that in the cutting out of my prostate I was entering new territory—possible sexual dysfunction and incontinence—which might radically change my life. And then, there was always the fear of the unknown.

Cancer, still today, when we know that many cancers are easily curable, is a word that sounds like a momentous proclamation to friends and family. But those who suffer this “proclamation” know that the most frightening aspect of suffering it is all the hundreds of lesser operations, checks, and doctor visitations one must endure that so completely alters one’s life. For those who are retired or even semi-retired these weekly alterations perhaps even come to define one’s life; for those, like myself, still actively working, they become fretful interruptions, as week after week, doctor’s appointments are scrawled across the mornings and afternoons of the calendar. One does not really get to know one’s doctors until a word like cancer or heart disease is spoken. Then, he gets to know them all too well. Dr. Redcross had found a cache of film scripts in his attic, one in French, and knowing that I was a publisher, wondered if I might read them and evaluate their worth. I was happy to have the opportunity to do something for him. Dr. Stein had known Howard through the museum, which, I am sure, helped him to control a bit his slightly forward and gruff manner.

Like everything else doctoring is a social activity, and “caring” for your patient may have less to do with “attending to” than with “a liking or a regard.”

When the day finally came, we arose at 4:00 to be at the hospital at 6:00. My palms were alternately sweaty or cold (a nurse commented on the later), but I was a obedient boy; if I had been told to lie down on the lobby couch, I might have without complaint. I recall little after the period of waiting to be checked in. Once upon the gurney, I basically became a child again, simply obeying everyone by answering the questions that needed to be asked. I do not remember being anesthetized, and I hardly recall awakening some 6 hours later—four hours in surgery and another two in the recovery room. I looked awful, Howard reports.

The room I occupied could not have been more spacious. We later were told that the nicely appointed (with an expensively covered couch, two chairs and a table) and partially carpeted space, was Cedars-Sinai VIP room in the VIP ward. When not being occupied by celebrities or wealthy patients who had paid extra for its use, it was simply given to the next patient that came along—and this time I was that patient. I loved to imagine that perhaps Lucille Ball, Frank Sinatra, Elizabeth Taylor, or Owen Wilson--all Cedars-Sinai patients at one time or another--had once slept in my bed. I hoped Britney Spears had not sullied it!

Yet that truly matters little to a hospital patient. For once one has entered the world of the hospital, no matter how well he is treated or opulent the room is, he is no longer an individual. Dressed in that dreadful and so easily opened hospital gown, he is now simply a body, and his private parts, exposed buttocks, or any other elements of that body have no value or interest to the scores of nurses and attendants except in their ability to heal. Almost all conversation shifts, accordingly, from events and ideas to a discussion of immediate bodily reactions that would never be discussed outside that institution. Bowel movements, the passing of gas, blood-urine content, etc. become the important conversations of each day. Accordingly, it is a nearly impossible to talk to visitors who are not willing listen to the evaluation of every ache and pain. And yet it is difficult, as a lying and sitting nearly nude body to speak of anything else. Marty Nakell and Rebecca Goodman stopped by the first night, a beautiful hydrangea plant in hand. I tried to talk with them, but found myself unable to concentrate, to refocus on the world outside my bodily rumblings and grumblings. In the end I was overcome by a feeling of nausea and was forced call the nurse. Embarrassedly I asked them to leave and come back again when they could.

When Marty returned, I was finally—after three days—feeling as if I would soon have a bowel movement. Suddenly, I knew my time had come. I had to ask him to leave again, as I ran to the bathroom, rewarded with my first bodily relief outside of the wonders of Vicodin.

I now understand why outsiders—as dear and friendly as they are to those imprisoned within—should be discouraged from visiting patients there for a short stay. Being a body is not being a friend.

But gradually, day by day, I did improve. I quickly gained the ability to get up by myself, to shave and sponge down my face, chest, and lower parts. I lugged my brother urine bag about and pulled along my sister IV machine—a monster from whom I was fortunately unattached when I began to drink liquids. Like other such recovering bodies, I trod up and down the hospital halls, but Howard’s attempt to strap on my walking urine bag ended with it slowly sliding down my leg, and we had to stop and ask nurses at another station for help.

Dr. Stein stopped by each morning, reporting on the third day that it appeared no cancer had spread to lymph nodes and had been limited to the prostate. There were no apparent signs of cancer in my body, but the cancer itself had been quite aggressive and dangerous. I am certain that had I not chosen to have it removed, the cancer would have spread.

Soon Howard became adept at changing my urine bag and I learned how to redress the cut described as my “drain.” We were ready to go home!

But in medicine there are always other possibilities. A doctor can never be entirely positive of any results. We’ll remove your catheter in another week. And then, about six weeks later, we’ll check your PSA again. It should read 0.0. If not, it might be possible that a deep-set node has become infected, but radiation will take care of that.

One day later, I sit here, at the computer, my abdomen slightly hurting, still feeling, every so often, as if I need to pass gas. The bed dress I wear is too warm for a September day in California, but it’s the only such bed gown I own.

Last night Howard asked me was there anything I liked about the hospital. I answered that—except for my joy in the room—my favorite moments involved the way the nurses prepared me for sleep, their final checks of temperature, blood pressure (which was near-perfect during my entire stay) and pulse, so reassuring as they tucked me in with my nightly cup of pills. It was soothing, like being a child again, as sleep rolled over me and I knew I needn’t worry about anything except getting well.

Last night I had terrible dreams: the medicines the nurses had given me had been embedded with beautiful images to hide the real world, the one we daily face. It had all been a trick, a kind of medical brainwashing, lies to cover up the truth. All night I tried to see through those lovely images, and every once in a while the curtain parted to reveal the more frightening world behind it.

This morning I had the equivalent of phantom pains: I swear I could feel my hospital identification bracelet just below my left hand.

Los Angeles, September 19, 2008

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