Dying is easy….comedy is hard
VANCOUVER ISLAND, CANADA –Timothy Leary; Frank Zappa; Dennis Hopper. Although all were born a decade or more before I was, they all feel like my contemporaries, as I grew up with them as seminal influences in my life. Each in his own way had his influence on me and, with many reservations and caveats, there was much in each of those men that I found to admire, respect, and even envy. From time to time I even come to believe that I have something in common with each of them. Whenever I stand back and look at our lives, I realise that although perhaps we don’t share that much; we do share one thing, however, that is indisputable. All three of those men died of prostate cancer. I have the same disease.
Prostate cancer is a disease that isn’t taken as seriously as some other cancers for a number of reasons. In its most common form it is a very slow growing cancer, for one thing. If a person is diagnosed with a low-aggression, non-metastatic prostate cancer of say, a 2 to a 4 on the Gleason scale at age 75, the odds are that the patient will succumb to old age if nothing else before the cancer becomes symptomatic beyond fairly treatable urinary symptoms. And that is the most common form for the cancer to take. Some oncologists speculate that close to 100% of men over 70 or so probably have cancer of the prostate and the wisest course of action is simply to monitor it and treat as one would for BPH (benign prostate hyperplasia)…you know, that condition that makes us men over 50 have to get up several times a night to squeeze out a few drops of urine.
So the disease, as long as it’s confined to the prostate , if not exactly asymptomatic, displays symptoms virtually identical to a benign condition that is quite treatable. Other means of diagnosis, most reliably a PSA (prostatic specific antigen) test can also show elevated PSA levels for a variety of reasons and don’t even always become elevated when the prostate is cancerous. Although testing the PSA level involves a simple blood test and is usefully indicative, it is far from definitive.
Far more reliable but extremely subjective and far from definitive is the all-time favourite digital exam. That’s the one where you bend over the examining table, your urologist snaps on the latex, lathers on the lube, and inserts a finger and feels for any anomalies or hardening of the organ. Not everyone enjoys this, so apparently I’m not an anomaly.
(The only good thing about my digital exam was the opportunity to deploy grotesque humour during the examination….
Doctor: “Please relax, the pressure and penetration you feel is my finger…”
Me: “So how come I feel both your hands on my shoulders?”
He had the good grace not to say that he hadn’t heard that one that week.)
Sure enough, the result was that he had detected anomalies and hard spots on the organ…next step…a biopsy. That one is all the fun of the digital exam, except that it takes a whole lot longer, a lot more people, and one hell of a lot of hardware has to do the spelunking and excavation. In this case, a director ensures that his camera boldly goes where, unless you spent some time on Cell Block C, no man has gone before; along with this, some other technician wields a device invented by the Spanish Inquisition and probes around as directed by Orson Welles and snips out (in my case) fourteen samples of tissue from a variety of interesting sites on an organ most of us aren’t even aware we possess and whose function remains a virtual mystery to science. When all of the hardware and tissue is removed from your Hershey Highway, you feel as though you’ve just passed a rather large rutabaga. And just to ensure that you retain good memories of the experience, both your urine and your semen are bloody for as much as weeks afterward. I’m not sure that that is a special effect the current spate of romantic vampire movies and TV series is ready to employ, although bloody, red semen is distinctly creepy.
They then look at these little chunks of tissue under the microscope and determine how aggressive the cancer is; it’s a complex formula, but in its simplest form 4-6 is intermediately aggressive and grows at a medium pace. 8-10 is very aggressive and grows and spread quickly; your prognosis depends on how early you caught it and whether it has metastasised beyond the prostate.
I came up with a 7.
So the next step is to do a CT scan and a bone scan. Those will tell if the cancer has spread to the surrounding soft tissue or the bones, respectively. If it has, there is probably nothing to do except treat for symptoms and wait until the cancer takes its inevitable course.
If it hasn’t, the normal course of action would be to insert radioactive seeds into the organ and attempt to destroy it and the cancer and surrounding tissue, or go old-school and simply lop out the offending organ, sparing as much of the surrounding tissue as feasible. Either way, the treatment is painful, undignified, leaves some very unpleasant side-effects (impotence is the most obvious, although it is usually susceptible to treatment with boner pills like Viagra), and takes a long time to recover. Until then the main downside is extreme fatigue, leaving it hard to work, let alone take care of a special needs and somewhat hyperactive four year old.
So there you have it. Cancer.
I can look squarely, if not enthusiastically, at all the unpleasantness for which I am in store. I can cope with hospitalisation, surgery, surgical recovery and after-effects, even death, should that become inevitable sooner than I had expected (of course, I expected to live forever). But it keeps occurring to me that it would have been easier if all this had come up just a little more than ten years ago.
I was single and wouldn’t be worried about leaving a widow whom I love deeply and is more than twenty years younger than I am. Moreover I wouldn’t be the father of a wonderful and special little boy who loves me and depends on me for virtually everything. I would not have spent hundreds of thousands of dollars on bribes and travel to get Indonesian civil servants to their jobs, because I thought there was ample time to earn that kind of money again. I would have gone to the police and the Corruption Eradication Commission and done it the right way, albeit the harder way, instead of doing it the traditional and easier way.
As it is, I find it hard to work because of chronic fatigue and I’m looking at my next significant birthday marking sixty years of existence on this planet (making me virtually a pariah in an industry that values youth). So, I contribute what I can when an editor buys something, I write even if my work isn’t bought by paying editors, because that’s what I do…I write. And I try to do that in between colouring with JJ, playing with his Spiderman and Super Mario action sets, taking him to preschool, on playdates with other kids, soccer games, swimming lessons and doing housework and cooking for both him and a wife who works full time while she waits for chef school to start in August. My disease progress remains unknown at this point, but I desperately want Yolanda to get started at culinary university because I want to ensure that she has a genuine career should I not be around to see JJ graduate from elementary, let alone high school. It never occurred to me that taking a few years off to care for my parents as they both succumbed to terminal illnesses would not just interrupt my career but interrupt it to an extent that when the interruption was over and they mercifully passed on, I would contract a similar disease that would possibly preclude the resumption of my own life’s work.
I never expected, after having been financially independent for as long as I can remember, to find myself virtually destitute, to be losing my house, being almost unemployable, and in grave danger of leaving a widow and an orphan with little or no financial security, after dying in poverty. Nevertheless, I am determined to maintain a sense of humour, love my wife, cherish my son and do what I can to continue as long as I can with dignity. Dying is easy….comedy is hard.
And I always strive to remember another quote from the Dylan song used for the opening title… it goes….”he not busy being born is busy dying….”