On My Way to Cape Town

I'm not like Julius Caesar

Hi Gary,

I’m on my way to Cape Town.  Overnighting in LA. Got a decent rate at the Crown Plaza; not a bad hotel.  Rooms large and clean, got one free drink at the restaurant, ate a Caesar salad to wash down the glass of house cabernet but was still hungry so I picked up a turkey club sandwich from the snack shop to chew on later, knowing I had some hydration waiting for me in the room – namely one of the tiny bottles of Dasani water I inherited from my Delta flight.

This last month has been a whirlwind experience.  Before we skied in Deer Valley, my urologist didn’t like my PSA, which had increased a bit from the last level so he ordered an MR scan of my prostate.  This was scheduled to occur a few days after our ski trip, the day before I would fly to San Fran to watch my granddaughters perform in the Wizard of Oz.  My urologist called me just before the first of two performances, ruining the first act with the news that they found a lesion on the MR scan that carried a 50/50 chance of being malignant using a new scoring system that had just been devised. 

Well, maybe it was this news or some other force of nature plus my daughter’s home in San Fran is never really heated to my liking.  I’m so cold that I wear my coat in the house.  And I fight getting out of bed to relieve myself in the middle of the night, leaving the warm that I have generated under the bed covers.  But whatever reason or reasons, I got really sick.  Felt like nothing I had experienced before. Bone pain (hip, shoulder), muscle aches but no fever or URI symptoms.  Hard to explain, but I could hardly move.  I was really scared.  But somehow miraculously, I made it back to Honolulu.  As I got off the plane, it seemed like my condition went from bad to worse and my right foot exploded with pain and edema.  Arriving Sunday afternoon, I somehow would have to recover before Thursday when my dreaded biopsy was to occur. 

On Monday, with a hot, swollen and throbbing foot and the help of my friend Al, we hobbled together, cane and all to my rheumatologist’s office.  I would leave two hours later after a battery of lab tests and x-rays, including a Doppler of my leg to look for DVT’s, a change in meds for my gout/ pseudogout, and a bigger than life injection of two cc’s of prednisolone into my butt cheek.

Somehow my condition improved over the next few days (we never really made a diagnosis) and I was able to get my biopsy performed in relatively healthy condition.   Being the baby I am, I demanded 20 mgm of Valium before the procedure to tide me over the worst of the anxiety and worry and for a little pleasurable high that was legal.  It was not that effective in relieving the anxiety but it was better than nothing.  Parenthetically, my only other experience with these drugs is just before colonoscopy when they inject you with Versed and Fentanyl and the 30 second high that you get moments before your brain goes blank is worth going through the disgusting procedure.  

The biopsy was painful this time unlike the first biopsy four year before.  This was a targeted biopsy that was mapped into the ultrasound machine with information transferred from the MR scan.  I was happy that there were only six needle biopsies taken, but it still hurt.  But there was blood everywhere when it was done, having ostensibly seeped out at the end of the procedure, which was unsettling.  In any case I was delighted it was over and we quickly got out of the medical center Ultrasound Department to find our way to Liliha Bakery to eat pancakes.  I was hoping for the results two days later, which would be Saturday, but it was Monday when the results were available and received the text message from my urologist, Dr. Charles Kim.  I had four days to worry.

Just have to mention how much I appreciate my urologist.  He is one of the best doctors I have ever been fortunate to call “my doctor”.  The first robotic urological surgeon in Honolulu, he is busy as anyone can be but he takes the time to explain things and empathize with my situation.  He personally walked me to and from the biopsy procedure.  Never seen that before in my life.  Dr. Kim, you are the best!

I was hoping for the best, but the reality is that I have had several prostate scares over the last 10 years not to take this lightly.  Sometimes I feel like saying – just get it over with and tell me I have prostate cancer and lets get the thing out of me for God’s sake.  And it seems like every male around me is either getting a prostate biopsy or getting diagnosed with prostate cancer.  So I spent the next four days worrying, and fretting and agonizing and for a break I re-read Patrick Walsh’s surviving prostate cancer book.  I went through the worst and the best scenario in my head a million times, resigned at times, defiant at others.  It was a miserable four days and all I wanted to know was the results of the biopsy so I could deal with it. 

I vegetated and could think of nothing else.  I was a Zombie in my own house, paralyzed by the fear of what I imagined would be my fate and how it would disrupt my life and my travel schedule which was utterly cluttered with trips.  South Africa, Canada, Vietnam, Korea all in the next two months.  And at times like this I always think what a coward I am and how much suffering I impose upon myself, instead of just thinking positive and looking the other way.  And then the Julius Caesar’s quote from Shakespeare always comes to mind.

“A coward dies a thousand times before his death, but the valiant taste of death but once. It seems to me most strange that men should fear, seeing that death, a necessary end, will come when it will come.”

And in the end, when I put it all together in my head, when thinking from my brain and not from the fear of the unknown, I was pretty sure the results would come back in my favor.  It just didn’t add up, the PSA wasn’t really that different, the MR scan findings leaned toward a lower score than a higher one, and I had been faithfully eating tomatoes and drinking green tea and mostly a diet that my prostate would consider healthy.  Nothing really had changed in the last six months.  But my positive expectations at the 11^th hour did little to ameliorate the suffering of the previous 96.

At this moment, I am happy as a drunken clown.  Monday morning at about 7:30AM I received a text from Dr. Kim….it read…..  no ca, call you later.  The biopsy simple read normal tissue.  A few words went a long way to relieving my pain and suffering. 

This is now almost three weeks past me but I wanted to share this awful experience with you since you are my friend and as my friend I expect you to experience vicariously some of the unpleasantness of the aging process and your friends cowardly response. Well now I’m exhausted, reliving this experience on paper but I can finally put it behind me and I can focus on my trip to Cape Town and the cruise to follow. And I’ll be sure to eat a lot of tomatoes and drink green tea…..hopefully my next email will be a little more uplifting. 

Hope you are well.  Write soon….

David