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A Real Sting in the Tail: Five Years On

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A Real Sting in the Tail: Five Years On HUMANITIES | ENCOUNTERS A real sting in the tail: five years on n Cite as: CMAJ 2020 August 10;192:E931-2. doi: 10.1503/cmaj.200316 ive years ago, I underwent exten- sive surgery in the uncertain hope of ridding my pelvis of a “high- Fgrade” prostatic tumour. My father and paternal grandfather had been felled before their time by the same curse. I wrote about events in the first 6 months,1,2 describing a difficult early course while making some suggestions about improv- ing care. Alive and well in 2020, I look back over half a decade to balance the bene- fits and costs of key decisions along a rather atypical journey — in other words, was it all worth it? After those first reflections were pub- lished,1,2 I received unsolicited invitations to talk at provincial and national confer- ences. The warmth of responses aston- ished me. There were handshakes and hugs, in particular from female physicians, for a man talking about things that men do not discuss. Perhaps I had put too much out there but, on rereading the stories and reliving events, “je ne regrette rien.” Time passed. Family and friends looked to me to advise loved ones on prostate- related investigations and operations. I did so where my experiences might be rele- vant, while cognizant that mine was not a typical experience and events that I described might not apply to others. In this context, two new long-term friendships were born. One was in the United Kingdom Dr. Maelanie Dobson with a happily married ex-rugby–playing Dr. Graeme Rocker at Mount Etna, Italy. septuagenarian; we still enjoy laughing over pints while discussing our current magnificent new Tottenham Hotspur We both had to endure 33 sessions of realities. In a recent wonderful example of (Spurs) stadium in North London. radiotherapy, an unhappy challenge. hope springs eternal, he mentioned look- One of my UK medical school chums, Three years ago, with a blip in my ing forward to a prescription for a new now a near-retirement specialist, had prostate-specific antigen (PSA), a bio- erectile dysfunction–related lotion and endured a tortuous time after a more chemical recurrence came as a stark whether, at some suitable weekend away recent prostatectomy in which every- reminder of my mortality. After an mag- with his wife, maybe … . Kerpung! thing that could go wrong did, even in netic resonance imaging (MRI) scan had Again in the UK, friendships with old his esteemed university hospital. Subse- refuted the earlier somewhat concerning school friends have been rekindled, lead- quently, he had a recurrence in the computed tomography (CT) report that ing to delightful brunches and dinners, prostate bed. We should take nothing suggested a secondary deposit (it was a timed to coincide with matches at the for granted. I had a similar recurrence. remnant of a seminal vesicle) and sensing © 2020 Joule Inc. or its licensors CMAJ | AUGUST 10, 2020 | VOLUME 192 | ISSUE 32 E931 indecision on my part, my radiation erections.” So it has proved. Some men trains.4 On a smaller scale, I have recre- oncologist simply said, “Why wait?” never do get over it. There is much depres- ated the tracks, stations, fields and steam I did not wait but, with some embarrass- sion among patients after prostate sur- trains of my early childhood, near the ment, stumbled at the first hurdle. To min- gery. I have been lucky in that regard (the London to Birmingham main line, and imize any radiation injury a pelvic “fry” mental health side of things), though I did delight in the landscaping skills I have requires a full bladder and an empty colon. dip sometimes into dark spaces early on. acquired over many years. Sadly, I lacked the skill to keep a full bladder This could probably be offset if men took a Close to home in Halifax, I walk the local HUMANITIES while expelling some gas and was sent lead from women and talked to fellow trails and greet the dogs. I enjoy each sum- away to refill! Attending 33 daily sessions travellers about these things. mer mile astride my more than 40-year-old gets tedious, as does being asked each time I hear and sometimes read about Moto Guzzi. I have stepped aside from a to give full name and date-of-birth (a policy advances in prostate cancer care. No one provincial leadership role with the to ensure rays reach the right person). Set should go through unnecessary biopsies or INSPIRED COPD [chronic obstructive pul- against other more aggressive treatments surgery. New techniques offer less chance monary disease] Outreach Program (www. elsewhere, I should have been more compli- of incontinence and the dreaded specter of nshealth.ca/content/inspired-copd -outreach ant, but I struggled with surrendering yet impotence, but only time will tell if pre- -program), treasure memories and friend- another modicum of personal control. Time serving this aspect of being male is the ships from a long and varied career, and passed faster with Pink Floyd on the sound gold standard rather than a radical had a lovely retirement bash recently. Life system. Some days I would bring my own approach to cure. I wrote in an earlier blog is not a dress rehearsal. Uncertainty builds music, often listening quietly to Richard post about what for me were some absurd- around each six-month PSA check, uncer- Strauss’ Death and Transfiguration, which ities (“have you tried a feather duster?”). tainty that is typical of hypervigilant cancer somehow seemed apt. Who knew it would take three and a survivors, but so far, so good. Without my Ultimately, I neared the end of radio- half years for the painful orgasm-related, esteemed specialists in urology and radia- therapy. My radiation oncology physician electric shocklike sensation in my rectum tion oncology where would I be now? Not authorized two sessions a day for a couple to dissipate? Did my severed nerves find a on the right side of the grass for sure. They of days in the last week. Why? So I could get new place to attach? How common is pushed me to make bold decisions about to a Premier League game in London as per this — who talks about such things? treatment that were not options for my my request! My wife (who knows all about More important, though, in all of this father and grandfather.1 I could not have DNA repair at a molecular level) was has been the wonderful support of my made those decisions alone and I am eter- appalled, but then she is a much more sons and especially my brilliant wife. I nally grateful. Yes, without doubt, it was all recent Spurs fan. On my last day, I handed must have been hell to live with in the worth it. out chocolates to the radiation team. There early stages, and on and off since, but we were hugs, especially for one woman whose are enjoying life and love, and fine ends to Graeme M. Rocker DM gentle hand on my shoulder as I entered the our professional careers within our “new Division of Respirology, Queen Elizabeth II machine was a welcome reminder that equilibrium.” The marital bed is still a Health Sciences Centre, Halifax, NS health care should be about caring. happy place, which makes the point that No day goes by without fleeting remind- while the male of the species places much References ers of the physical consequences of missing value upon a traditional attribute, their 1. Rocker GM. A real sting in the tail. CMAJ 2015; nerves. Every shower, every bathroom trip female partner, especially in longstanding 187:440-1. is a minor rerun of that wonderful Seinfeld relationships, is quite likely to be more 2. Rocker G. Category: Graeme Rocker [blogs]. Ottawa: Canadian Medical Association; 2015. Avail- 3 “shrinkage” episode when George and his desirous of feelings of intimacy. I hope this able: https://cmajblogs.com/category/patients lady friend discover the consequences of a is something to encourage other similarly -blog/graeme-rocker/ (accessed 2020 Apr. 28). fated men. When my wife and I emerge 3. “The Hamptons.” Seinfeld [TV show], season 5, cold-water swim. In the absence of a blood episode 21, National Broadcasting Company, supply to erectile tissue, that tissue withers from isolation related to coronavirus dis- aired 1994, May 12. on the vine! Like George, we just need to ease 2019 (COVID-19), there are enticing 4. I am railing: Sir Rod Stewart reveals his epic prospects of travel along special railway model railway city. BBC News 2019 Nov. 13. get over it or embrace penile health as pro- Available: www.bbc.com/news/entertainment moted by some clinics! lines in England or where my nascent Ital- -arts-50403561 (accessed 2020 Apr. 28). I described in my earlier blog posts ian takes us. I recently took some classes eschewing opportunities to use a plastic and then rediscovered Italy itself after an This article has been peer reviewed. vacuum pump that would bring blood absence of 30 years. I am hooked. Acknowledgements: Beyond many supportive back under negative pressure. Others, in So, five years on, with recent undetect- friends and colleagues, I would also like to extend special thanks to my esteemed special- similar circumstances, go that route. I do able PSA and with no need, as yet, for ists, Drs. Ricardo Rendon and David Bowes who, recall with crystal clarity the conversation antiandrogen therapy, I am told that I am while modestly claiming they were just doing with my urologist on day one, when he living the dream.
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