Your PSA is too high
6.8 and climbing
Need to check it out
It’s been two years
Drop your trousers
Drop your drawers
Bend over
Spread your legs
Here’s a tissue
You’ll want one
Did she just giggle?
Snap of surgical gloves
Nah! She wouldn’t do that
Not gonna be a great day I think
Do you know what a DRE is?
Here’s a clue
The D stands for digital
Yeah! That digit
That’s what a DRE is
It’s a digital rectal exam
The one where they jam their finger
then their hand
then their forearm and shoulder
and finally their combat boots
up your ass to see how your
prostate is doing
It’s a golf-ball sized gland
Just for men
Right above the rectum
The urethra goes through its middle
It’s next to the lower bowel
Just beneath the bladder
Pretty important for us guys
What’s it do, you ask?
Well, blush
It helps make sex slippery
and gooey and lots more fun
Note: It’s also the first three letters of DREAD
Not a coincidence I think
Relax
Take a deep breath
Think about something else
Sure
I wonder if she took her wedding ring off
Big ring
Tall ring
Sharp ring
I think she did giggle
Get ready
Here we go
Uhhhh!
It has an abnormally rough surface
Could be an infection
Need to rule that out
Antibiotics for a month
Antibiotics kill infections
They also kill all the nice little critters in my gut
The ones that keep me healthy and regular
Kills ‘em all
Kill ‘em in the morning
Replace ‘em in the afternoon with probiotics
Kill em again the next morning
5.7 a month later
Still too high
Rubber gloves again
I know the drill
Drop ‘em …
Now I know she giggled
I think she hates me
Uhhhhhhh!
Need to schedule a biopsy
Same position
One month later
Drawers down
Different facility
Different doctor
A Urologist this time
Terse, efficient, female
“You’re gonna feel some pressure.”
“I’ll bet!”
She wears boots too
Big boots
She has a pistol in her hand
Its got a needle in the end
Looks like a toy I had as a kid
You jammed it into a raw potato
Sucked out a core sample
and shot ‘em at your friends
Now I’m the potato
Not Yukon Gold of course
I’m just an old russet
Full circle I guess
Two nurses
One tech
One urologist
And a stranger
All female
“Is it okay with you if she observes?
She needs the experience”
Five women standing there looking
at my bare ass
Sure, why not
Bring the whole damned school down
We can do theater-in-the-round
Everybody gets a good look
Maybe you can even touch it
I’m trying to be cool
Play the old man card
Nonchalant
Devil-may-care
Bon vivant
Urologist’s not having it
Big needle
She hates me, too
Uhhhhhh!
Four imaginary quadrants
Twelve samples
Three from each quadrant
Click
Click
Click
Times four
One month after that
Different Urologist
Different location
“Did you bring someone with you?”
(Geez, talk about letting the cat out of the bag!)
“No.” (Your bedside manner sucks, doc)
Test results
A Gleason score of 7.0
Cancer critters in all four quads
Do the math
PSA + Gleason + age = high dosage radiation
+ testosterone suppression treatment
They call it Androgen Deprivation Therapy or ADT
Isn’t that cute
It’s chemical castration
Like they used to do to child molesters
Two months of radiation
Two years of ADT
Gotta go to Seattle for the radiation
They’ll put me up
Pay my per diem,
Fifteen-minute treatment each day
Hang out for the rest
For two months
Two long months
Gotta be a better way
Second opinion time
Call my son in Kansas City
He’s an Interventional Radiologist
He’ll check with his colleagues
Call a couple of local treatment centers
non-VA
Radiological Oncologist says six weeks max
Do it right here in town
Does it for the VA all the time
Gotta get permission though
My son calls
Urologists there recommend 2 months
VA here recommends 2 months
Radiologist says 6 weeks
Do they read the same journals?
Son says no
Takes too long
Too much information
Changes too fast
Hard to stay abreast in your own discipline
October now
It all started last April
Little cancer critters still chomping away
They don’t take weekends off
Or holidays
Or need breaks
Or vacations
Or sleep at night
Or have to make appointments
three weeks in advance
But we do
Have to start hormone shots six
weeks before radiation
It weakens the cancer critters
They eat testosterone
Open warfare now
Scorched earth
Gonna starve ‘em
Then nuke ‘em
And nuke ‘em
And nuke ‘em again
For six weeks
Then we’re gonna starve ‘em
for a year and a half more
Supposed to keep ‘em from rebelling again
Gotta keep the moat full
The bridges up
The parapets manned
That’s the plan
First hormone shot on Friday
Friday after Thanksgiving
Black Friday
It should be slow then
I get a call on Wednesday
Gotta reschedule Friday
Why?
Doc got called for jury duty
Reschedule when?
Three weeks from now
Jury duty?
You believe that?
Not me
Nobody gets jury duty on Black Friday
You can get a four day weekend though
Jury duty my ass
Don’t get me wrong
Most VA people have been nice
Been professional, helpful and attentive
It is not the people
Mostly it’s the system
Like most bureaucracies
Appointments for instance
Take three weeks minimum
If missed or canceled
it takes another three weeks
It happened twice
I Lost six weeks
Chomp, chomp, chomp
They say more men die with prostate
cancer than of it
They also say that it’s the second leading
cause of death for men
Most prostate cancers are slow growers
Mine seems to be contained
For the time being at least
Won’t necessarily stay that way though
Eight months it’s been
I’ve waited long enough
I’m normally patient
Low key
Positive
Even fun to talk with some say
I roll with the punches
All that
But eight months of
PSAs, DREs, biopsies, bureaucratic
hoops, negotiations, canceled
appointments and no treatment yet
All the while my little cancer guys
are partying non-stop
Chomp, chomp, chomp
Chomp, chomp, chomp
The radiation is what kills them
I can’t start radiation for nine weeks now
Makes me mad
“I’d like to see the doctor please”
Tough guy
I want answers
I want movement
I want to get the goddamned shot
“Sure, the nurse will be fine, thanks”
“I’ll wait”
“Two hours?”
“You’re kidding?”
“Okay, I’ll wait”
“Still nobody, huh?”
“Maybe the janitor could do it?”
No backing down now
My hackles are up
The phone rings as I walk into my house
“Can you go to Roseburg tomorrow morning?”
“Be there at 10:00 o’clock”
I get my shot
The clock starts
Karen has been browsing
Reading up on prostate cancer
If you were in Viet Nam
Boots on the ground, 1962-1975
And you come down with prostate cancer
The VA presumes it was caused by
Agent Orange
Makes you eligible for compensation
I was there in 1967
I am eligible
And the damnable stuff never
was orange anyway
Nobody in the VA told me about being eligible
I had to find out on my own
That’s the only thing in this whole process
That really pisses me off
They really ought to tell people
Court says they don’t have to so they don’t
Saves them money I suppose
I filed my application on Dec 5th
A week after my first ADT shot
8 ½ months after this all began
Mid-January comes
Time for radiation
Get an MRI first
Establish a baseline
Calibration for the radiation gun
Three little tattoos on my belly
Helps line things up
My very first tattoos ever
Maybe I’ll do more
Who knows
Ready to go?
Wear sweats if you want
Need your bladder full
And your bowels empty
Do they know how old I am?
“Come on in, Marv”
It’s a big room
Thick door
A really thick door
Warning lights flash
Monster machine hovers above
Hi-tech gurney beneath
Science fiction come to life
Scene out of Alien
Nice music though
60’s stuff
Head here
Feet in the mold
Show us your tattoos
Hang on to this
A rubberized ring
Reminds me of a dog toy
Helps me be still
Red lasers crisscross my abdomen
They shove the gurney under the emitter
Align the laser lines with my tattoos
Stay still
Don’t move
Everyone leaves
Door closes
Just me and the machine now
“Hi, My name’s Marv…”
Click, whirr
Movement
Two high-tech arms reach toward my feet
Radiation tines of a radiation fork
Once extended they roll above me
Pass to the left
Pass to the right
It’s a CAT scan
All goes quiet
In the other room, they’re comparing
the CAT with the MRI
Fine tuning the gun
Getting ready for the big zap
Making sure they hit their target
That’s fine with me
“Could you fart just a little bit?
I’ve never been asked that before
I have been asked to quit before
I’ve practiced for this all my life
And now I can’t do it
Not here, not now
Not in front of three techs politely
trying not to hear
Just a little fart?
Will keep my bowel out of the line of fire
I need a bathroom
I need some privacy
Do you know how hard it is
to loosen your bowels
and not drain a full bladder
at the same time?
at least at my age
Gotta keep the bladder full
Keeps it out of the way too
Just a little fart
That’s all
Start again
Line me up
Check the marks
Take the scan
And wait
The gurney twitches
Once, twice, three times
They’re fine tuning the shoot
Hydraulic buzz
A sleeping behemoth awakens
It’s huge
The size of a dining table
Slowly it circumnavigates my body
Once to the left
Once to the right
I feel nothing
No tickle
No burn
No smell
Nothing
It’s an exercise of faith
Could be voodoo for all I can tell
The gurney rolls out
The techs are back
I’m done
Fifteen minutes
Every day for the next six weeks
I wonder if I’ll still need a night light
to pee?
There are some side effects
Not many
Not severe
Feels like I have to pee a lot
but can’t
Low energy near the end of a work week
First time in my life I left work early
because I was tired
Am I cured?
Too early to know
Supposedly I am
PSA won’t settle down for several months
We’ll set a new baseline then
Make sure it stays low and flat
Less than 1.0
Continue the ADT shots
Every six months for two years
Hot flashes
Night sweats
It’s getting easier to pee now
Flomax helps
I can live with it
Turns out I still need a nightlight
So now what?
Waiting on the VA claim
I’ll keep writing
I’ll keep taking pictures
Traveling when I can
Where I can
As long as I can
When asked why she still traveled so much
when she was in her eighties
a friend of a friend of mine replied
“Why not? I can die anywhere.”
That sounds about right
Marv Himmel
March 3, 2017 ©