Prostate Cancer | Writing by Yvonne Watterson

The man I love has cancer. And, after months of deliberation, of decisions made and decisions overturned, he has begun treatment. Radiation treatment. Every single day. For forty more days. With my own cancer treatment in the rear-view mirror, I thought I would just know how to help him, how and when to find the best and kindest words to lift him up, to quell the fear, to be “there” for him. Then I remind myself that the treatment of cancer is a private act with stretches of time spent in a surreal and solitary confinement. Along the way, I know I can point out some of the landmarks – detection, diagnosis, treatment, surgery, shame, depression, fatigue, fear of recurrence – but I know of no short-cuts. I know he is a stranger in a strange land.

Even if I were allowed to hold Scott’s hand during radiation therapy, while he lies perfectly still on a treatment table at the Arizona Prostate Cancer Center, he is still alone. Supine, his mind is ablaze with random thoughts ranging from the pedestrian to the philosophical. What if he sneezes? What if he dies before he sees his daughter grow up? Why in the hell did he get cancer in the first place because Goddammit he feels just fine? What if this was a mistake?

He will try to ignore the strategically placed signs above him – “Tell Cancer it has Two Months to Live.” “Hang in There.” You never know how strong you can be until you have to be.” “Together We Can Beat This.” Skeptical and uninspired, the man I love is an unwilling conscript in this battle.

Healthy, handsome, fit, Scott wasn’t supposed to get cancer. It was supposed to happen to someone else, someone with a family history, someone who didn’t go for routine physicals, someone who didn’t feel good – someone ‘destined’ for it. Not him. It wasn’t supposed to happen to me either. I remember once upon a time when I thought breast cancer was the thing that was supposed to happen to other people, to celebrities who grace the pages of magazines, to women who didn’t show up for their mammograms, to women with a family history. It was not supposed to happen to me.

Denial works for us, doesn’t it? It’s why we travel on airplanes. We know they might crash – but never when we are on board.

The first night we met, he told me about the cancer. Over beers and banter, we sized each other up and over-shared, checking off boxes our middle-aged online personas had created on a dating site. A musician, he told me he loved Bob Dylan and golf and taking to the road on his Harley Davidson. Regaling me with the stuff of good first impressions, he glossed over a comment about illness and aging. A dog with a bone, I pressed for details, and in a “you go first” moment, I laid my cancer card on the table. Buoyed by this, he shared that he had been diagnosed with prostate cancer four months previously. He was still considering his options and assessing the damage of various treatments for prostate cancer. I had just met him, and already I knew he was bruised and alone and drowning in fear of what was in store for him. He was in the waiting place.

All Alone!
Whether you like it or not,
Alone will be something
you’ll be quite a lot.

And when you’re alone, there’s a very good chance
you’ll meet things that scare you right out of your pants.
There are some, down the road between hither and yon,
that can scare you so much you won’t want to go on.

~ Dr. Seuss

Just as I had known nothing about breast cancer until it happened to me, I knew nothing about prostate cancer or the details of its treatment. As evolved as we are, we still refuse to entertain certain diseases, disorders, addictions and ailments in polite conversation. Unlike the common cold, its symptoms unapologetically made public with persistent sniffles, sneezes, loudly blown noses, and a tell-tale trail of balled-up Kleenex in its wake, the symptoms of prostate cancer can often go unnoticed, revealed only after a physician suggests a routine screening to men over 40. Such was the case with Scott, when his first digital rectal exam and PSA test indicated they should keep an eye on his prostate. There was no sense of urgency, however, and I imagine he told himself that most prostate cancers found by screening are small and insignificant. Slow-growing, they may never cause any problems. In his research, I’m sure he also found that for some men, false positive PSA results lead to painful biopsies which show that there is no cancer at all. Others will endure biopsies that find cancer, but the cancer might not grow quickly enough to be life threatening. Sometimes these cancers are unnecessarily treated with radiation or surgery accompanied by a host of side effects that nobody wants to talk about – infection, incontinence, impotence – leaving men like Scott to ponder silently their mortality and their sexuality as they contemplate their next move.

His induction into cancer country followed a brutal biopsy in October 2015. There’s no delicate way to describe the procedure during which an ultrasound probe is inserted in the rectum to help guide the long thin needles that will collect tissue samples from the prostate. To help reduce pain, numbing gel is applied to the rectum, and an injection of Lidocaine is inserted directly into the prostate. But it’s just not enough. As his story unfolds, unvarnished and uncensored, I can’t help but drift back in time to a darkened hospital room, my physician telling me to take a deep breath, “Lidocaine going in. Little pinch.” and then a staple-gun click as the spring-loaded needle opened to take the tissue sample from my cancerous breast – four times. In my mind’s eye, I see the kind radiologist who looked into my eyes and said, “I’m so sorry you’re here,” right before he shot three painful injections of radioactive dye directly in and around the nipple of the right breast that would be removed the next day. I wince, even now, writing about it. But what I remember most and more than the sting of those injections is the genuine kindness of that radiologist right before he administered them, and that nothing is stronger than the human heart.

Howl on.

One needle at a time, Scott tells me the urologist took 12 sliver-like pieces of tissue from his prostate. After the first one, the doctor cajoled, “That wasn’t too bad, was it?” Hyperventilating, Scott said it hurt like hell, aghast at the prospect of eleven more – eleven more – but he bore down, and he endured it, swearing to himself that he would never do it again. In the days that followed, he grew accustomed to painful urination, blood and bits of tissue in hie urine, to the indignity of it all. Then he learned that several of the specimens were pre-cancerous and that his urologist had scheduled him for another biopsy. This time would be in the hospital and under general anesthesia. This time, they would collect 36 samples. This time, they would find cancer. He was now in “the kingdom of the sick,” along with over 3,085,209 men living with prostate cancer in the United States. This year, the American Cancer Society estimates 161,360 men will join him.

For over a year, he weighed his options. He considered active surveillance which would necessitate annual biopsies such as those he had experienced prior to diagnosis. Such watchful waiting, he feared, might give the cancer a chance to grow and spread therefore limiting his treatment options later. He thought about surgery. He thought about radiation. He thought about what his urologist would do if he were in his shoes and asked him outright. He asked me what I thought. I didn’t know what to tell him other than whatever decision he would make, it would bring with it a shadow of a doubt, and he would have to make room for that – forever.

Finally, he opted for Calypso radiation treatment. Also known as GPS for the body, it keeps radiation focused on the tumors, not the healthy surrounding tissue, thereby reducing the likelihood of side-effects. The process begins with a procedure not unlike the dreaded biopsy, another stop on what he calls the “doctors-up-my-ass” trajectory. Lying in a fetal position, his knees to his chest, he squeezes my hand while the urologist numbs the area around the prostate, inserts the probe in his rectum, and then places three tiny electromagnetic beacons through a long, thin needle. The doctor tells him he’s doing great and that I am too. The nurse smiles, as though to affirm that this is an entirely normal scenario. Somehow – surreally – the urologist and I are chatting about about Ireland, his daughter’s favorite country, while Scott is squeezing my hand so tightly, I can’t feel my fingers. It is a brief procedure and painful, but the Valium has taken just enough of the edge off. The nurse explains there might be some bleeding over the next day or two and not to be alarmed by blood in his stool or urine or the fact that his semen may appear rusty for up to 12 weeks. She tells him to avoid working out or lifting anything heavier than 10 pounds for at least three days. And off we go.

“No turning back now, baby,” he tells me as he prepares for 44 days of radiation treatment.

So he shows up – albeit reluctantly – every day at lunch-time for a dose of radiation. I’ll send him a text around 11 o’clock reminding him drink up – the goal is to drink just enough water to ensure his bladder is as full as it was the day before. This helps reduce the risk of movement and therefore the risk of other organs receiving any radiation. In my mind’s eye, I can see him at the sink, filling his water cup with 34 ounces of water, carefully positioning the cup to conceal its Cancer Center logo from his co-workers. I force myself to drink 34 ounces of water too, somehow believing if I also have a full bladder, I am closer to empathizing.

Obedient, silent, and perfectly still, his skin marked with three little tattoos that help ensure his body is correctly aligned in the machine, his musical ear attunes to the high pitched frequency of radiation being delivered to those three tiny electromagnetic beacons implanted in his prostate. Each of them no bigger than a grain of rice, they communicate with the Calypso system using radio-frequency waves, letting the doctor know where the tumor is at all times during the session. It is the stuff of black and white sci-fi shows he watched as a child.

Outside, I wait, crafting make-believe stories in my head about the men who are also waiting. Once, I waited in the wrong waiting room with a trio of older men already dressed in their scrubs, and passing the time criticizing the host of a HGTV show for cheating on his wife. I liked being in their company. It brought to mind the time I taught a Freshman Composition course to a group of men at Boeing who, in spite of their tenure in the company, were required to earn a degree – reminiscent of Happy Hour in a dive bar, except for the questions, “Hey darlin’, what’s a dangling participle?”

Jovial, avuncular guys, they shoot the breeze about the weather and the Masters tournament and the cute wife of the HGTV show host. I know they know I’m in the wrong waiting room, but they don’t say anything. I know they are waiting for me to leave to they can wonder aloud about me. I must be with the new guy. As the nurse bustles in to escort me to the other waiting room, I notice there is already a cubby with Scott’s name on it and inside it, a pair of navy scrub bottoms for him to wear during radiation. Initiated, he’s the newest member of the club. Already, he knows when it’s his turn on the treatment table. Already, he knows that it is Jim’s turn before his, and then it’s Bobby’s turn. Already, it is a routine, taking me back to all the times I placed my clothes in a plastic “Patient Belongings Bag” and stowed them in a tiny locker outside a mammography room – to a strange time, when I was part of a strange sisterhood, where an instantaneous intimacy allowed us to talk about being poked and staged and prayed for. I did not want to be immersed in that culture and railed against it, but it enveloped me nonetheless – as it will Scott. I tell him we are at once apart from and a part of it – from the inconsequential chatter with cheery assistants who call to confirm appointments, to confidences we feel compelled to share with those who wait with us in waiting rooms. The milk of human kindness flows in such places.

Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.

~ Susan Sontag

But in this other place, Scott still doesn’t believe it’s happening to him, which explains why some people closest to him don’t even know about it. Cancer pushes a lot of buttons, you see. It changes us, forcing us at the most inconvenient of times to confront our mortality. It can transform us into great pretenders, and so we distance ourselves from those who love us most – out of fear and self-preservation, or indignation and anger about the fact that our number simply came up, or maybe out of denial and shame and all the other words that belong in the recommended self-help books that we cannot bring ourselves to read. Sometimes we don’t know what to do or say, and we might even turn our backs on the people we used to be. And then in a rare moment of clarity, we realize that’s no way to live, that something good is coming, and that love never fails.