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 HUMANITIES “shrinkage” episode is a minorrerunof that wonderful nerves. Everyshower,everybathroomtrip ers ofthephysicalconsequencesmissing health careshouldbeaboutcaring. machine wasawelcomereminderthat gentle hand on my shoulder as I entered the were hugs,especiallyforonewomanwhose out chocolatestotheradiationteam.There recent Spursfan.Onmylastday,Ihanded appalled, butthensheisamuchmore DNA repair at a molecular level) was my request!Mywife(whoknowsallabout to aPremierLeaguegameinLondonasper of days in the last week. Why? So I could get aday for acouple authorized two sessions therapy. Myradiationoncologyphysician E932 somehow seemedapt. Strauss’ music, often listening quietly to Richard system. SomedaysIwouldbringmyown passed fasterwithPinkFloydonthesound another modicumofpersonalcontrol.Time ant, butIstruggledwithsurrenderingyet elsewhere, I should have been more compli- against othermoreaggressivetreatments to ensureraysreachtherightperson).Set to givefull name and date-of-birth(a policy gets tedious,asdoesbeingaskedeachtime sessions away torefill!Attending33 daily while expellingsomegasandwassent Sadly, I lackedthe skill to keepa full bladder requires afullbladderandanemptycolon. imize anyradiationinjuryapelvic“fry” ment, stumbledatthefirsthurdle.Tomin oncologist simplysaid,“Whywait?” indecision onmypart,radiation the downside.“There wouldbenomore going foracure.”Hewasquiteclear about said withsomeconfidencethat, “Hewas with myurologistondayone, whenhe recall withcrystalclaritytheconversation similar circumstances,gothat route. Ido back undernegativepressure.Others,in vacuum pumpthatwouldbringblood eschewing opportunitiestouseaplastic moted bysomeclinics! get overitorembracepenilehealthaspro- on thevine!LikeGeorge,wejustneedto supply toerectiletissue,thattissuewithers cold-water swim.Intheabsenceofablood lady frienddiscovertheconsequencesofa No daygoesbywithoutfleetingremind- Ultimately, I neared the end of radio I didnotwaitbut,withsomeembarrass- I describedinmyearlierblogposts Death andTransfiguration, which 3 when George and his whenGeorgeandhis Seinfeld CMAJ -

Sir Rod Stewart’s passion for model before COVID-19. I have long shared coffees withlocalcolleagues and friends living thedream.Ienjoyedlunches and antiandrogen therapy,Iamtold thatIam able PSAandwithnoneed, as yet,for absence of30 years.Iamhooked. and then rediscovered Italy itself after an ian takes us. I recently took some classes lines inEnglandorwheremynascentItal- prospects oftravelalongspecialrailway ease 2019(COVID-19),thereareenticing from isolationrelatedtocoronavirusdis- fated men.WhenmywifeandIemerge is somethingtoencourageothersimilarly desirous offeelingsintimacy.Ihopethis relationships, isquitelikelytobemore female partner,especiallyinlongstanding value uponatraditionalattribute,their while themaleofspeciesplacesmuch happy place,whichmakesthepointthat equilibrium.” Themaritalbedisstilla our professional careers within our “new are enjoyinglifeandlove,fineendsto early stages, and on and off since, but we must havebeenhelltolivewithinthe sons andespeciallymybrilliantwife.I has beenthewonderfulsupportofmy this — whotalksaboutsuchthings? new placetoattach?Howcommonis to dissipate?Didmyseverednervesfinda electric shocklike sensation in my rectum forthepainfulorgasm-related, half years Who knewitwouldtakethreeanda ities (“haveyoutriedafeatherduster?”). post about whatformeweresome absurd approach tocure.Iwroteinanearlierblog gold standardratherthanaradical serving thisaspectofbeingmaleisthe impotence, butonlytimewilltellifpre- of incontinenceandthedreadedspecter surgery. Newtechniquesofferlesschance should gothroughunnecessarybiopsiesor advances inprostatecancercare.Noone travellers aboutthesethings. lead from women and talked tofellow a This couldprobablybeoffsetifmentook dip sometimesintodarkspacesearlyon. mental healthsideofthings),thoughIdid gery. Ihavebeenluckyinthatregard(the sion amongpatientsafterprostatesur- never dogetoverit.Thereismuchdepres- erections.” Soithasproved.Somemen | AUGUST 10, 2020 So, fiveyearson,withrecentundetect- More important,though,inallofthis I hearandsometimesreadabout | VOLUME 192 | ISSUE 32 trains. their consenttoappear inthisnarrative. The author’sfriendsandhiswifehave allgiven and gavemehope. their job, did much more thanthat. They cared while modestlyclaimingtheywere justdoing ists, Drs.RicardoRendonandDavid Boweswho, extend specialthankstomyesteemed special- friends andcolleagues,Iwouldalsoliketo Acknowledgements: Beyondmanysupportive This articlehasbeenpeerreviewed. 4. 3. 2. 1. References father andgrandfather. treatment thatwerenotoptionsformy pushed metomakebolddecisionsabout on therightsideofgrassforsure.They tion oncology where would I be now? Not esteemed specialistsinurologyandradia- survivors, butsofar,good.Withoutmy tainty that is typical of hypervigilant cancer around each six-month PSA check, uncer is notadressrehearsal.Uncertaintybuilds had alovelyretirementbashrecently.Life ships fromalongandvariedcareer, -program), treasurememoriesandfriend- nshealth.ca/content/inspired-copd-outreach monary disease]OutreachProgram(www. INSPIRED COPD[chronicobstructivepul- provincial leadershiprolewiththe Moto Guzzi.Ihavesteppedasidefroma mer mileastridemymorethan40-year-old trails andgreetthedogs.Ienjoyeachsum- acquired overmanyyears. delight inthe landscaping skillsIhave London to Birmingham main line, and trains ofmyearlychildhood,nearthe ated thetracks,stations,fieldsandsteam Health SciencesCentre,Halifax,NS Division ofRespirology,QueenElizabethII Graeme M.RockerDM worth it. nally grateful.Yes,withoutdoubt,itwasall made thosedecisionsaloneandIameter-

Close to home in Halifax, I walk the local Close tohomeinHalifax,Iwalkthelocal -arts-50403561 (accessed2020Apr. 28). Available: www.bbc.com/news/entertainment 13. model railwaycity.BBC News 2019Nov. I amrailing:SirRodStewartrevealshisepic aired 1994,May12. NationalBroadcasting Company, episode 21, “The Hamptons.”Seinfeld[TVshow],season 5, -blog/graeme-rocker/ (accessed2020Apr. 28). able: https://cmajblogs.com/category/patients Ottawa: CanadianMedicalAssociation;2015.Avail- Rocker G.Category:Graeme[blogs]. 187:440-1. Rocker GM.Arealstinginthetail.CMAJ2015; 4 Onasmallerscale,Ihaverecre- 1 Icouldnothave -