All over bar the shouting
The results are in. I just don’t know what they are yet. It’s been really nice that people have wished me good luck, or reassured me about the odds of a good outcome. But it makes no difference to the answer. Nothing can change that. It is – as I keep saying – what it is.
It is the same feeling you get after the last exam of the summer. As soon as you put your pen down, and the last paper is collected, the outcome is literally out of your hands. The result is predetermined, barring a deranged marker or a mix up with the papers. No amount of subsequent wishful thinking or a positive attitude will make any difference to the grade. You may as well forget all about it, relax and wait for fateful results day.
Like a prospective MP waiting for the count. The polls are closed, the voting slips are being stacked into piles. Barring any mistakes, nothing can affect the outcome. The candidates can just smile and wait for the counters and the ultimate announcement.
It’s not really helped for people to reassure me with predictions, or tell me they are convinced it will be fine, that I should stay positive. Their support and kindness is lovely. But the result may or may not be fine. All the good thoughts in the world won’t change it. It will be what it will be.
Others have quoted favourable statistics. The odds are in my favour. Well, lots of things are in my favour, including my fitness, slim figure and avoidance of drugs, poisonous snakes and dangerous sports. But again, statistics are irrelevant when applied to a single person. It’s a yes or a no, a binary choice, an Boolean expression. 66% probability or a 1 in 5 risk is meaningless for a population of 1. It’s either 100% or 0%. All or nothing. One or the other.
Shaking in the Netherlands
This whole thing kicked off in the middle of the night last November in a remote hotel in a village in Holland. I woke up shaking – uncontrollably. My mind was alert, I wasn’t cold, but my limbs were vibrating violently all by themselves. I didn’t know whether to be intrigued or terrified. I tried wrapping myself up to no avail. I could just about walk, but I was still shaking madly.
Was I having a fit? My father had suffered with epilepsy – was I having an epileptic fit? I tried to look at my phone. My hand was shaking so much I couldn’t keep it still enough to read, nevermind type. Attempts to google anything helpful were doomed. I finally managed to post a coherent status on facebook – partly as a cry for help, partly in a fatalistic gesture, to record what was happening in case I was about to slip into a coma. At 4am in the morning, neither tactic was particularly sensible in hindsight. So in the end I just lay on the bed and hoped it would soon stop. And after another 20 minutes it did. Just as suddenly as it had started. I hardly dared go back to sleep.
In the morning I passed blood in my urine before breakfast. Never a good start to the day. Later that morning, in a smart, efficient Dutch medical centre, a very helpful English-speaking doctor prescribed me antibiotics, explaining that I probably had a bladder infection. It all seemed rather disappointingly straight forward, except that she was particularly insistent that I saw my own doctor when I got home. It is very rare, she explained, for men to get a bladder infection, because our plumbing is different. She didn’t need to draw the diagram.
With my travel habits and Christmas, it was January before I could get an appointment back home – and then it was a temporary doctor rather than my usual GP. She was excellent, talking me through the whole thing, and sending me away for blood tests, urine samples and (whilst I was at it) an x-ray on my painful big toe. That one was easy – it is arthritis from old age, not a break. So I could carry on running. And the man who did the blood test was disconcertingly friendly and warm for a man who inserts needles and takes blood for a living.
I was back with the same doctor in February. My blood test had revealed a PSA of 4.5. Prostate-specific antigen is a protein produced by cells of the prostate gland. A score over 4 can suggest prostate cancer.
My father died of prostate cancer, which he contracted at precisely the age I am now. I had had a urine infection. I get up most nights to visit the bathroom (a habit I am more inclined to blame on my 10pm red wine habit). It all added up to a “risk”.
She recommended she carried out a digital rectal exam. Without going into details (try not to imagine them for yourself), I was glad that (a) she was a woman with small hands and (b) I would probably never need to see her again. It was conducted with as much decorum, respect and modesty as is possible in the circumstances. She examined my prostate – it was slightly enlarged.
On the other hand, she reassured me, men of my age can often have a raised PSA and an enlarged prostate. It was smooth rather than wrinkled. My bladder infection could be something unrelated. Predisposition to prostate cancer can be inherited – but there is not such a strong genetic correlation as there is with some other cancers. All of which added up to uncertainty.
“So what are the statistics?” I asked. “One in three” she answered. The only sensible thing to do was to find out if I was the in the one, or in the two. I agreed to see a consultant at Leicester General, have a kidney scan at Leicester Royal and enjoy a cystoscopy (I had a choice here) at Loughborough hospital.
Scans, probes and indignity
The kidney scan was a nice, gentle, relaxing Sunday morning experience. I lay on a bed whilst a nice, friendly man ran a warm ultrasound device over my back and mid-riff. He was rather pleased to find a 7mm kidney stone. According to no less an authority than the internet, my wife discovered, this could be a cause of an infection. Meanwhile, she had also had discovered that PSA levels could be raised within 48 hours of a strenuous cycle ride. I checked my diary – and yes I had cycled two days before my blood test. I checked the internet again. There are no conclusive studies but “strenuous” suggest Bradly Wiggins proportions. I closed my browser. Nothing good comes from researching medical conditions on the web.
My appointment with the consultant was less pleasant. He was a very nice man, with a very nice manner. But he had large hands and was far less gentle. He didn’t think my prostate was enlarged – and he said was bad news, as this in itself could have explained the higher PSA. So he recommended, and I agreed to, a biopsy.
My wife already had an appointment in March at the Leicester General, so we decided to make it a day out. She can’t complain that we never go anywhere together.
A pain in the bum
The appointment was at 1.30. An hour later I was still waiting. The letter had told me to keep my bladder full – which it turned out was unnecessary. All part of their mischievous medical humour I guess. I was called into a small room with one doctor and three nurses. This was going to be cosy. The clever part is how to take off your trousers and pants and lie on a bed, under a sheet and only expose your bum. A nice bit of choreography direction by the senior nurse.
So basically they push an ultrasonic probe up your rectum – and have the (well) cheek to tell you to relax. This is followed on behind (ooo er) by a metal device which pokes through to your prostate and extracts a sample. It is a strange feeling – a sharp pain, like an insect sting, deep inside. Except then they told me they normally take 12 samples. This was not going to be pleasant.
I looked at the senior nurse with pleading eyes, “talk to me” I said “about anything”. She smiled pitifully and asked me what I did for a living. No sooner had I explained that I worked in IT, that the computer system they were monitoring the process on failed. Apparently it was showing distorted ultrasound pictures of my inner organs. Which, fortunately explained why my bladder was in the wrong place.
I offered that 90% of computer systems are fixed by switching off and switching on – trying to sound professional without my pants on. The doctor whipped out the probe rather too quickly. First he rebooted the computer, then he rebooted the probe. Haha – you have to laugh. It didn’t hurt any less the second time in, but it was less of a shock.
By snip 4, I was losing my spirit as quickly as I was losing parts of my insides. I was desperately trying to focus on reciting the names of the cities I visit when I work in the Nordics. The fact I was lying there with my bottom on display was no longer the problem. It was the anticipation of the next snip-snap. Fortunately, by the time I got to Gothenberg we were at sample 12 and it was all over, bar the shouting.
I reversed the “getting off the bed and getting dressed without exposing any dangly bits” procedure. As a final ignominy, I was given what I can only describe as a nappy to put inside my pants. “Do I really have to?” I pleased, like a small child being told to wear an embarrassing pair of trousers for school (I remember it well). Yes, he did think it was advisable. For me it was simply adding insult to injury.
As I leaned over the desk to hand my notes in to the receptionist, I was sure the residents of the packed waiting room were sniggering whilst taking snaps on their mobiles of my strangely shaped and enlarged rear end. All over facebook.
It was an uncomfortable ride home, followed by days of unpleasant after effects which are available on request. I found a discussion board for men who had had the same “procedure” (as they euphemistically call it). It is one of the funniest dialogues I have read in a long time. There is a gap in the comedy market for a male Victoria Wood to recount stories of men’s lower body health experiences.
The cystoscopy – when they stick, hopefully a considerably smaller tube in another sensitive orifice – is scheduled for Monday.
And finally . . .
But meanwhile – the final results are in and I get them tomorrow. After my biopsy, I asked the nurse if I could see one of the samples. She showed me a milky white thread of my prostrate, maybe a centimetre long. I wondered whether it contained any tiny cancer cells. Each of the 12 samples is from a different part of my prostate. They send them off to the lab, to be soaked in chemicals, sliced up and looked at under a microscope. This has all been done now. Someone who I will never see or know of sound mind has carefully (I hope) completed this exercise and written down the results. And the paperwork hasn’t been mixed up. He or she knows the answer. I don’t. But it is what it is now.
I read today that prostate cancer kills 10,000 men a year. But also that it is very slow to develop and is eminently treatable, if caught early. The chances – for what chances are worth – are that I am clear. If I am not, the chances are very good it will be treatable. At some low levels, they don’t even recommend immediate treatment, they just monitor it.
I don’t feel like I have cancer – but then what would it feel like if I have?
There has been a humorous side to people poking around my rear end. But, I have to admit to have been pretty stressed about this whole thing. I have been even more reactive, moody and sensitive than normal. But I have also been warmed by the reaction and support of the few people I have told – and by one man in particular who has been uncharacteristically caring. There is some male solidarity at the (excuse me) bottom of all of this.
So yes, the results are already in. Let’s go straight over to the announcement. Tomorrow at around 10.40 I will sit in the consultant’s room and hold my wife’s hand. The envelope will be opened and the verdict proclaimed. It is what it is. I either have cancer or I don’t.
You know, I really hope I don’t, but unfortunately hope won’t change anything. Nothing will change what’s in my body already. But the knowledge – one way of the other – will seriously change what’s in my head.