Coming Face to Face With a Diagnosis of Cancer

Saturn, Uranus, Neptune.

As an aerospace engineer and interplanetary navigator, I’ve been to all those places via the Voyager mission. Done ‘em! My life is fraught with adventure every few years, one planetary encounter after another. But I’ve never done Pluto. Never been to that deep dark place full of shadow, cold and potential finality. I get a chance now. If you are one of about 200,000 men in the United States facing a diagnosis of prostate cancer this year, you may also qualify for the trip.

It all comes down to an adventure. Never mind if it’s good or bad. I won’t know for another few hours--if ever. The unknown beckons: danger, excitement, risk, reward. Only the “if ever” gives me pause.

They come for me, two orderlies, men, black and white, eyes hiding deference, pity, boredom. They fiddle with the gurney outside the door while I fiddle with my thoughts. Is it too late to run down the hallway, smock flapping in the breeze exposing my bare bottom, screaming, “No, no, no, not me, not today, not ever, take somebody else!”

No. Not too late until they lock me down in drug chains. Not too late to scream, but I don’t. Instead, when they are finally ready and look expectantly in my direction, I give a big jump into the air and click my heels together. Come down smiling--ta da!--and climb onto the gurney. They’ve never seen that, I’ll bet. Never!

I’m cold, and the first thing they do is drape blankets over me. Warm blankets, fresh from the heater. I’m grateful and shrink up a little so they can cover the length of my body, neck to toe.

Down the hallway feet first. Bye-bye, Jan, I love you. Bye-bye, don’t worry.

Down the hallway on my back, feet first through doors, past busy doctors and nurses and waddling patients, reminds me of the pregnant woman in the movie “The Meaning of Life” on her way to a rendezvous with delivery and “the machine that goes beeeep!”

*

Four months earlier I had grunted with pain as a doctor probed my guts with a thick plastic / metal wand pushed up my anus. The pain isn’t bad--bearable, certainly. It’s the pain of injured dignity that hurts most. I see the shadowy outline of my prostate rolling and sliding across a video screen as the doctor watches intently. OK, let’s get some samples, he says. I steel myself.

Snap . . . Snap. Six times snap, the tiny needles dart. At least it’s sudden, a quick bite and tug, over instantly. A small quick pain, and it’s over. As I pull my underwear and pants up, he tells me to expect a little blood in my urine for a day or two, and I might have bloody semen for a month or so. I’m a little shaky, have to walk gingerly, but it’s not too bad. We’ll get the results Monday, he says. Make an appointment. Monday? Today’s Wednesday. I have to wait almost a week?

*

The score of the prostate specific antigen (PSA) test had been climbing for years. I’d gotten the first one when I was 49, and it was below 4. Four years later it had climbed almost to 7. Worrisome, but not alarming. Finally, when it topped 10, I had my first biopsy. That was last year. Negative. Relief. I know it was a relief, because I cried. After two days of agonized waiting, I received a call from the nurse on Friday, who said, I just want to let you know right now so you won’t worry over the weekend that the biopsy was OK.

I held it together for a few polite words of thanks, but as soon as I put down the phone, alone in the house, I was a ball of tears. Oh, God, oh, God, yes, oh, God, thank you. And I don’t even believe in God.

Over the course of the year, the PSA had dipped down to 9, then climbed again, above 12. Now, when I’m 55, the biopsy is easier, the wait easier. But this time is different. I have a new doctor. A new nurse ushers me into his office to wait. The formal office, the VIP office, the good-folks office, plush carpet, walnut furniture all around, books and diplomas lining the walls. Not the usual steerage patient’s room with the intimidating paper-topped examination table.

Uh-oh. This can only mean one thing.

Something turned up in two of the needles, the doctor says. Oh? I answer, but I already know. Cancer! I have cancer. My status has changed with the status of the cells picked out of the tips of the needles. I am now a cancer patient, and people will look at me differently, those who know. But somehow this time the news is easier than the false alarm of the year before, somehow it’s almost old news, has the aura of calm inevitability, humdrum fact.

With this doctor I’m almost unconcerned, almost jaunty. He says: You need surgery before this stuff breaks out of your prostate. I say no way, I’m not missing the launch of the spacecraft I’ve put seven years of my life into. We agree on a hormone treatment to put me into a holding pattern for four months to shrink the cancer.

The countdown begins. Two months later, Cassini thunders off the launching pad on its way to Saturn while I gird for my trip to Pluto.

*

The day before surgery, I came for the lab work and the final pre-surgical evaluation. My EKG has a glitch. Don’t worry, it’s nothing, the surgeon says. I have a mild temperature, and my blood pressure, which is usually quite good, is sky-high, 205 over 102. Don’t worry, the nurse says, but she takes it again with a frown on her face, and this time it comes up 195 over 96 and she’s satisfied. What’s the threshold? Don’t worry! I’m not worried, I am worried. They’re going to operate on me like this?

Over the last several years, the surgery has become a lot less bloody and shorter in duration, meaning there’s less trauma to recover from. Since 1994 the typical duration went from four hours to two or three; the hospital stay, from five days to three or four; and the recovery that used to require eight weeks now needs four to six weeks. Why? Technique, the surgeon says, and shrugs. We just keep on getting better. Still, this is major surgery, and there is a non-vanishing probability of complications leading to death. Small. But not zero.

In the middle of this internal chaos, a minor earthquake hits, gently swaying the building, obviously a foreshock to the magnitude-9 disaster that will inevitably occur tomorrow while I’m opened up on the table.

*

The hour before, as I waited in the room with my wife, my bladder was in turmoil. I had to pee every five minutes, though it was after 9 a.m. and I hadn’t eaten since 10 the previous evening. Where was it coming from?

Now again in the holding room, an urgency asserts itself. This is insane, I think, as the nurse lets me off the gurney and I pad alone down the hallway in smock and paper booties, searching for relief, a calf straying from the slaughterhouse queue. The bathroom is locked, occupied. I wait and wait. Insane! Finally the door opens. A cleaning lady. Oh, pardon me, she says, slipping by. I pee and think, This is the last time I’ll do this for a while. If ever.

The anesthesiologist--a small, intense woman--comes over to fiddle with me. I smile and say hi, but she’s not much for small talk. She searches for a vein in the back of my left hand, inserts a needle and tube, tapes it down. It irritates at first, but later I will hardly notice.

*

Our outermost planet is cold and dark, getting 900 times less heat and light from the sun than does the Earth. You will experience no discomfort upon arrival, however, because you will be in a state of suspended animation even darker than Pluto, void of memory, dreams, consciousness or even existence.

Next week: The return to Earth

*

Tony Taylor, an aerospace engineer who writes novels, works at the Jet Propulsion Laboratory.