Prostate Cancer is the Least of My Problems

 



People ask me how depression feels. I reply with a number of similes, mostly related to metal. It is like wearing medieval chain mail, a lead suit, an iron diving helmet, a set of prisoner restraints. It's physical, heavy, and comprehensive, rising from the calves up over my head. Anxiety is similarly physical, except that it's prickly, like I'm a pin cushion. Or there's a circular saw buzzing down through my head and I'm cross-eyed. Sometimes, it's both at once. Dreadful hopelessness makes me want to die. There's no reason to get out of bed. I just want to go. This has gone on for more than a year and a half. The medication, Effexor, Buspirone, and Gabapentin, has no effect. I sleep only by Trazodone and wake up like a zombie.

 

Aha. How necessary it was to set the scene: radiation treatment for prostate cancer. They say you have to be positive to get through it. You have to want to live. What life do I have and what do I return to with a successful treatment? Prostate Cancer is the least of my problems.

 

My dear son Manny. My dear brother Alan. My sister Judith. My dogs. My uncle Nathan and aunt Ann. My writing and photography. The beach in the summer. Honeycrisp apples. Vietnamese Pho. Rice and Beans, fried plantains, yuca with mojo. The Village Vanguard. The films of Almodovar and Robert Altman. A crisp, sunny day. A yoga class. Cuban music. Pictures of my mother. Conversation. I'm getting tired of the New York Times but I'll list that. All these things go through my head. On any given day they're more or less successful ways to bait me out of complete despair.

 

I have to admit, there's just something about being Jewish. "Like my cardiologist said to me, no matter what happens to us, Job, for example, we always get up." Moses got us out of slavery, and that's pretty bad, like the worst thing that can happen to you. Well, the Romans flayed Rabbi Akiba's skin with steel combs. Later on, there's the crucifixion, but it has the silver lining that you always get resurrected. We don't go for that. There's always a little light no matter how dark it gets. Maybe I'm just scared of weapons. The only Jews thick with guns are the Israelis. That's a lot of Jews with guns. I don't know how many use them on themselves. Maybe there's a hidden epidemic.

 

This is too hard.

 

 

 

Tomo Therapy: Hi Art

 

A group of market specialists and scientists gathered around a long conference table and decided upon a logo for their machine, "Tomo Therapy: Hi Art." It was developed in the early 1990s at the University of Wisconsin-Madison by Professor Thomas Rockwell Mackie and Paul Reckwerdt.

"Tomotherapy or helical tomotherapy" [HT],  according to Wikipedia, "is a type of radiation therapy in which the radiation is delivered slice-by-slice." As for "Hi Art," either the assembled group had pretensions about their mission or there were art historians invited to the event.  Being one, I conjured up Claes Oldenberg's "Soft Toilet" (1966), a whimsical reflection on that everyday porcelain fixture. I wondered if that is what the art historians brought to the table.

 When I first saw the machine, I thought of  the Holland Tunnel. Then I thought about the "Fleshlight," but don't get me started, because it didn't feel very good when I was inserted. Soft Toilet it would be. Afterall, I was feeling like shit when they slid me into the hole and felt a little better once I got out of there.

In truth, as they lined me up and slid me into the orifice, my arms closely crossed on my chest, I imagined that I was a torpedo being slid nearly flush into its tube on a submarine.

From transportation, sex, and bathroom metaphors, I finally settled on a military one. With laser precision, they wanted to shoot me out the back of the mechanism right at the cancer. Cancer is pretty tough and resilient, and metastasizes at will, just like ISIS. So they have to shoot at it a lot, like five days a week for nine weeks. What keeps us going is this determination to "battle" our cancer, just as the War on Terrorism has taken such a long time. The military metaphor is common, but not everyone thinks about it the same way.

For instance, my mother was diagnosed with Melanoma in 2008 and spent over two years "battling" it. That's a long time. In her mind, when they slid her into the machine--her torpedo tube--she imagined that she was "fighting the terrorist," which was her cancer. She was so spirited and so positive in her anti-terrorist campaign until they told her in the Spring of the third year that they could no longer continue her in the clinical trial. ISIS is pretty much decimated after four years, but my mother didn't win her battle. Very quickly, she got very depressed, withdrew from the world, and died on May 30, 2011, eighteen days after Mothers' Day and two days before my birthday. I always looked forward to my birthday, because it fell just after Memorial Day and augured the summer, when I could swim in the ocean on the Second Avenue Beach in Bradley or at the Deal Casino. We spent fourteen years (1959-1973) baking in that glorious oven, most of it without sunscreen. That must have been how my mother got that Melanoma on her forearm.
 

Silvia Cohen Brown, January 28, 1932-May 30, 2011

The First Day

With so much cold lead filling my body from toes to forehead, I couldn't move very well. Lead, that's how it felt, except with a pound of even colder terror attached to it. I sat by myself in the changing room in that silly gown, open at the back, and cried for a while. It was the first day of radiation.

After my diagnosis of prostate cancer and the biopsy, which showed a Gleason Score of nine--highly aggressive--the urologist was infectiously positive. He slapped me on the back and exclaimed, "You're going to do just great! These days, men don't die of prostate cancer, they die with prostate cancer." All it would take was a course of radiation over nine weeks, five days a week. So now it was upon me.

For two months half a year ago, urinating was urgent, painful, or impossible. As the 200-hour yoga training was coming to an end, my PSA was 18. The urologist told me that my prostate was "hard" and "irregular." How I loved those special moments with the doctor, after which I used tissues to get the lube off me. The catheter became a way of life on and off for over two months. On, when I couldn't pee; off, when the doctor wanted to see how the Flowmax was working. It didn't work. I writhed awake several nights in excruciating pain as my bladder went into spasm. In the morning I begged the urologist to put the catheter back in. Of course, the tube in my penis and creepy bag hanging on my leg made the yoga all the more enjoyable. At the teacher training graduation in March, the bag, my new friend, pushed against my bluejeans like a ferret that crawled up my leg. I felt like a hundred years old and looked it in the group photograph. I had this frozen, shocked look that was out of step with the young radiant yogis around me. The rose petals sprinkled all over the floor looked like blood. I must be a sad sack, because the sweetness of the occasion was lost on me. Why couldn't I do great like the doctor assured me?

The TURP, Trans-Urethral Resection of the Prostate, was successful. As the anesthesia was making me sleepy, the urologist came by and told me again that I was "going to do great," and it reminded me of "Make America Great Again." Well, voila. I was able to pee again. When you tell them you can pee again, they always ask you how the "flow" is, and I had to say "whoopee!" Still, I never quite got over the image of getting "reamed out," as a description of the procedure. There was a lot of reaming going on in that hospital, especially when the invoices started to arrive and my insurance deductible was doing some laughing at me. I was doing great.

Dr. San Sim, the radiation oncologist at Monmouth Medical Center in Long Branch, was a calm and reassuring presence. He agreed with the urologist that surgery was not an option, because the aggressiveness of the cancer would not permit them to get all of it, and I would have to have radiation anyway. I was lucky, he said, because the CAT scan showed that the cancer had not spread outside the prostate, for example, the lymph nodes and the bones. The prostate surgeon Robert Weiss, of Robert Wood Johnson in New Brunswick, concurred. So radiation it would be.

After two treatments, where they strap you to the board with a body mold and line it up to the four tattoo marks I now have, I'm not quite philosophical. The most I could do to get though it was yogic breathing. Concentrate on the dristhi at the bridge of my nose; pay attention to the edge of my nostrils as the cool air comes in and the warm air goes out; inhale one two three four; exhale one two three four. It offered some consolation.

Mine Goes Up to 11

E.J. and I fist-bumped as I left my first radiation treatment. He was sitting in his gown talking on the cellphone in the long waiting room with the fake wood handrails. "I'm graduating tomorrow. It's my last radiation treatment,"  he said. "What about you?" 
     "It's my first day," I replied. "How many days has your treatment been?"
     "21 Days," he said.
     "So what was your Gleason score?," I asked.
     "I think it was 20 or 19."

I looked at him, pretty sure that the Gleason score only went up to 10. Mine is 9, I thought. His must be 9. I was reminded of the 1984 movie, "This is Spinal Tap," where Nigel Tunfel's amplifier goes up to 11. E.J.'s Gleason score can be whatever he wants it to be.

It was my first time in this room with the high ceiling they call "The Vault." There's this big machine that looks like the Holland Tunnel, but made out of soft-looking plastic. I had to take a picture of my profile on the computer screen and another one of the tunnel. Melissa asked me what I wanted to be called, Mr. Brown or David. My immediate response was, "call me Dr. Brown." I take pictures and ask to be called Dr. Brown when I want to stay in control.

Have you ever had to lie down on this long moveable slide, where they pulled away your hospital gown and the registration plate felt really cold on your ass? I have (homage to Tom Pappa).

All kinds of things are going on in this Ph.D.'s head. I want to die right now. No, I want to publish my Cuba book before I die. After that I want to die. No, I want to write this blog and then publish it as a book before I die. Then I really want to fucking die, but not before I take it on the road in the combination book signing and stand-up comedy show I'm planning.

I sent the manuscript in PDF format to Academica Press, which I know nothing about, except that it sounds good. They wrote me back and said, "didn't you get the message that we want it in MS Word so we can work on it?" I told them I sent it in PDF format for security, and asked why they would be "working on it." I thought it was just to review and I'd receive a letter saying they had agreed to publish it. What kind of press was it that started editing any manuscript sent to them. "Sure! We accept anything anyone sends us, just as long it's in MS Word." Hey, do I really want to publish with that kind of press? The only person they wouldn't publish would be Jack Kerouac, whose wrote his first draft of "On the Road" in one sitting on a long roll of paper.

"This Ph.D's Prostate Cancer Blog" has to be about Prostate Cancer, or anything that comes into my goddamned mind. It's got to be worthy of the Marx Brothers or, at least, a New Yorker cartoon.

When I was a The Pingry School for Boys, Dave Rapson said that I was the "master of the one liner." That's from all the Marx Brother's movies I watched a hundred times and memorized in Gordon Berkow's "Cinema 26" on Clive Hills Road in Edison at age 13. How come my son Manny says that I now talk in paragraphs? I owe it to Oberlin College and Yale Graduate School. That's about what my father said to me too. David, you've just changed.

I've had no sense of humor for two years. I haven't been able to tell a joke or even laugh, except once or twice watching Bill Maher. Things have to be really dark. Gallows humor is pretty much all I can do now.