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Ralph Gilbert, a successful Newton businessman, is striking back against prostate cancer with the best weapon a man can wield: his humor. He has owned and operated three Boston-area hotels and been president of Temple Emanuel in Newton. He holds degrees in Mechanical Engineering and Architecture from M.I.T. These days, he is a full-time writer of memoir and fiction, including the gem below, a CommonHealth exclusive.
Listening to Patients — the stories of individuals and how they cope with illness — is a regular feature on CommonHealth. See a previous post on pancreatic cancer here.
NO LAUGHING MATTER
by Ralph Michael Gilbert“See a doctor,” my wife said.
“Why do I need a doctor, honey? I don’t need a doctor. I won’t see a doctor.”
“Go!” she said. “Find out what’s wrong. At your age, who knows what it could be?”
“Nothing’s wrong with me, and what’s wrong with my age? I’m fine. I won’t see a doctor.”
I was, at the time, an otherwise healthy 68-year-old man, happily married to Paula for the past 44 years. She was a loving and sexy woman. I had developed a frequent urinary urgency that compelled me to lurch off the highway at high speeds whenever I spotted a stand of more than three trees.
“Go,” she repeated.
On my first visit to Dr. K’s office, after an unpleasant, probing examination, he determined that my enlarged prostate was affecting my stream.
“We can measure this,” he said. “Please make an appointment.”
Ten days later, I took a seat in his windowless waiting room in Brookline, Massachusetts. The air conditioner was set on stun. I couldn’t feel my fingertips. He had told me to drink six glasses of water and to hold it. I was desperately holding it, but just barely. Pain shot through my belly. A cold sweat lined my shirt collar. My bladder was a hard marble. I watched the clock slowly tick 45 minutes past my appointment time. I sighed and rocked back and forth. I noticed that the patient across from me was trying to avoid eye contact.
Finally, a pretty young woman in a lab coat approached.
She pointed to a door. I sprang up and pushed it open. An apparatus was attached to a sink.
She flipped the switch. “Please direct your stream into this. It takes a minute to warm up, so please wait. Mr. Gilbert, wait! Wait! Wait!”
Too late. My penis was giving the orders now.
Later, in Dr. K’s office: “We didn’t get any results. None at all. Too bad,” he said with an amused smile.
“Your P.S.A. numbers, however, do seem to have changed since we looked at them last. I’m going to recommend a biopsy.”
“Now, nothing to worry about, just a simple test, a very simple test,” he said, getting up and walking toward me.
“Not now!” I said, clutching my testicles.
“No, no, no,” he laughed, “not right now, later.”
“Not now, I need to see my accountant today.”
“No, no, not now, you’ll make an appointment with my secretary. You’ll come back, next week, right here in my office. The whole procedure will take place right here in my office. Don’t worry. Nothing to worry about, really. Just bring your wife to the next appointment.”
“My wife,” I replied, “what for? Why do you need her?”
Paula was a survivor of uterine and breast cancer. She had completed her radiation treatments a few years ago. We no longer worried about her cancer, but still, we never forgot about it either. Was he going to test her also? Was there something wrong with her? I didn’t think she had a prostate, but who knows? Was it catching, what I had? I really didn’t know. He was the doctor. He should know.
“Well, it’s going to feel, well, a little uncomfortable. It will pinch a little each time I take a sample. You might not feel like driving home. You may need someone to drive you. You know?”
I made an appointment with a young woman who was sucking on a hard candy and having a whispered telephone conversation. It didn’t sound like urology business. She managed to book my appointment without making eye contact or speaking my name. She knows about me, I thought. I slunk out.
The day came for my appointment. Dr.K. was late again. Why can’t he get to his appointments on time? I thought. And what exactly does “It’s going to pinch a little” mean, and why couldn’t I drive myself home? What the hell was going on? By the way, how does he manage to get a tissue sample of an organ that was located inside my body? I tried not to think about it.
My name was called and I was asked to remove my clothes except for my socks. I changed into a thin cotton smock with strings in the back too short for me to tie. The room was cold. I was completely exposed below.
“Good morning, Dr, K.” I said, forcing a smile.
“Hello, Ralph,” he replied.
I wondered at his first name greeting to me. He was much younger than I was. I had been ‘Mr. Gilbert’ previously, but now, without pants, I had become: Ralph, Ralphy-boy. I realized that any formality in the past had been compromised by the fact that I was now standing before him with a hospital gown too short to maintain my dignity.
Up on the table, he came at me from behind. Being an engineer, I imagined him using a long slender stainless steel cylinder with a hook at one end to get the sample. I hoped that I was wrong.
“Now, just relax,” he breathed. As the cold stainless steel probe touched me, I let my mind flow into a Zen state. I grabbed the cold bar of the narrow table. I tried to go into a state of hibernation. I knew that bears could do it, so why couldn’t I? I tried to separate my mind from my sensory function. Then, suddenly, I felt an extremely unpleasant fullness in my lower bowel. This was followed by a perfect starburst of pelvic pain.
Zing! Wow! It stung like crazy!
“Ahh, that was a good one.” He breathed into my ear.
I stifled a sob.
“Okay now, just a few more,” he said, his head right behind mine. I could feel his breath on the back of my neck, his voice strained. “We need to get at least six good ones to make a representative sample.”
Zing! “Wow” Zing! “Oh boy, oh boy.” Zing! Zing! Zing! And then it was over.
“That wasn’t so bad,” he offered. My whole body quivered.
“Well, we’ll just have these samples looked at. Please make another appointment, and once again, please ask your wife to join us.”
The next week I was back in his office, with Paula. This time, he was wearing an expensive, cashmere, double-vented blue blazer, crisp white shirt, and a yellow rep, power tie. His medical credentials covered the wall. A picture of him receiving an award from an elderly, bearded, little man sat on his desk.
“I have the results, Ralph.” His lips were tight and his eyes focused on the report.
He lifted the folder and began to read. I couldn’t see his lips. My hearing is not so good so I really needed to see his lips in order to understand. I could feel my pulse pounding in my ears. He said a lot of words. I couldn’t hear or understand them all, but it amounted to “cancer of the prostate.” (I had never thought much about my prostate, and now it had cancer.)
The prostate, as you may know, resides in intimate proximity to the male sexual organ. Removal, notwithstanding what they tell you, involves the severing of certain nerves, which usually results in loss of sexual function. Prostate removal also results in diminished bladder control. Incontinent and impotent, I knew I should never have come.
Paula reached over and held my hand.
“But, Mr. Gilbert, in time, eighteen or twenty months, your symptoms could mitigate, slightly. You could regain—”
I sighed. I had spent some time in the U.S. Military, and I knew bullshit when I heard it.
“Now, Ralph, if you don’t like your chances with surgery, I could melt the gland with high doses of radiation, or I could insert radioactive seeds into the organ. If you choose this option, however, once you recover, you would have to use a condom when you have sex with your wife.”
“What! Why’s that?”
“Well, you wouldn’t want to ejaculate radioactive seeds into her now, would you? You see what I mean, don’t you?”
“No! I mean, yes! I mean, I guess so.” I began to sweat.
“Or, for that matter, if you don’t like these options, (he seemed to warm to the possibilities), I could freeze it first or, (his words now flowing from his mouth like a thick viscous fluid) if you like, we could treat it with hormones and shrink it and…”
“What kind of hormones?” I asked.
“Well, female hormones. You know?”
“Female hormones! Well, wouldn’t that…?”
“Yes, it would, but not permanently.”
“It’s all up to you, Mr. Gilbert. You decide,” he said, slamming the folder shut.
I went to see someone else for a second opinion, but before I did, I had lunch with an old friend, who himself was an urologist and a surgeon.
We dined together at a very smart restaurant at the Charles Hotel in Harvard Square. Seated at the other tables were bow-tied university men and straight-haired women, drinking white wine and speaking in sophisticated tones.
“You could do nothing, Ralph,” he said. “Simply not disturb the cancer and let it grow as it would. This is called ‘watchful waiting,’ but I don’t recommend it. If the tumor progresses to your spine, you could die an extremely painful death.”
“Well, Les, you don’t have to sugarcoat it for me,” I said.
His face was impassive.
How could we be so casually discussing my death in such a charming spot? So many happy diners were drinking and laughing. Waiters attended our every need.
“Hey, Les,” I whispered, “if the bladder is connected to the urethra which passes through the prostate, how do you get the bladder to connect up once the prostate is removed?”
“Oh well, Ralph, that’s simple. We just pull a part of the bladder down to the top of the penis and staple it.”
I dropped my fork.
* * *
The next week was scheduled for fishing with my buddies: Mike, who had a cabin near the Esopus River; Bill, the insurance guy; Phil, the engineer; and Big Al. I hoped that the quiet, dark corners of the river would provide me with solitude to consider my options. Perhaps the timeless spring cycle of rebirth would put my own little problems into perspective. It didn’t turn out that way. I grieved for myself. Why me? I cried actual tears. Alone on the river, I couldn’t stop crying. I plodded with my rubber hip waders, through a sticky mud of self-pity. In the evenings, I couldn’t follow the jokes. I laughed at the wrong places, sometimes before the punch line or not at all. I got looks. They all knew. I was getting to be a pain in the ass. I drank a lot of Irish whiskey, a lot. During a candid conversation on aging and the male sex life, Big Al said: “I use the testosterone patch.” A dozen empty crushed beer cans lay at his feet.
“It makes me a hard old man,” he said, breaking into a roar, which signaled that it was time for everyone else to laugh. The next morning, I got up early. The sun sparkled on the river, and the Earth gave off a musk that promised a new season of minnows, chicks, and budding flowers. Spring was celebrating, but not with me.
* * *
The operation to remove the gland, a radical prostatectomy, was performed at the Massachusetts General Hospital. My first memory upon awakening was a short, big-busted, black nurse, with a lilting Caribbean accent.
“Good morning, Ralph. How are you?” Then, without waiting for a reply, “My name is Juba and I’m here to show you how to change your bags.”
My hand reached down under the thin sheet and realized that I was attached to an apparatus and this one lone sheet was securing my modesty. Juba firmly grasped the sheet and whipped it off. I was still groggy from the anesthesia but I thought she said: “My, that is one good-looking penis!”
“Thank you,” I think I politely replied.
Finally, after I was shown not only how to change bags, but also how to engage in good penis practice, I was released. I was given a bottle of 25 Percocet tablets and told to stop using them before they ran out. This, to learn discipline with the potentially addictive pills.
In a few days of home experimentation, I found that taking Percocet with copious amounts of strong, black coffee was able to transport me, in my daydreams, to a small jet plane flying low over the Pacific at a terrific speed. Flying just above the waves, the sun rose ahead of me. The angle of the sun hit the undulating surface of the ocean in such a way as to create an endlessly changing rainbow-kaleidoscope of color and flashes of sunlight. Dynamite! I could lie in bed and fly along all morning until I ran out of black coffee and Percocet. The only problem was that my bag filled quickly.
On my second evening home, Paula put me to bed early. Under the influence of the Percocet, I slept soundly. At about ten that night, I awoke suddenly in the moonlit bedroom. I couldn’t remember where I was. I looked around and saw, to my amazement, a blond woman in bed with me, with her head on the pillow next to mine. Oh my God! The moonlight was diaphanous in her hair. She was not my wife. Who was she? Think! I demanded of myself. Who is she and what am I doing here and where is here? Where am I?
I looked again. She was not, after all, the classic beauty of my dreams. As a matter of fact, she was a dog, my dog Bailey, who must have missed me and gotten into bed. I bent down. He kissed me on the lips. I appreciated the gesture, but worried about where his tongue had been previously.
I endured the period in which the catheter was engaged. A day came, according to my written instructions, when the device could safely be removed. I could either make an appointment with the doctor, the memo read, or I could remove it myself. I was sick of being doctored, so I asked Paula to assist me. She joined me in the bathroom. I stripped naked. Her face showed alarm when she got a good look at the tubes hanging out of the business end of my penis. I knew that Paula had regretted not having trained as a nurse. She had always wanted to be in medicine. This was her big chance.
“Okay, honey,” I said, while separating the color-coded tubes coming out my penis, “get me sharp scissors.”
Her eyes slowly rolled back in her head, her tongue lolled out of her mouth, and she slid down the wall.
“Honey. Are you okay? Get up! Please stand up! Please!”
She sat, immobile, staring straight ahead. I got the scissors and cut the blue tube as indicated in the defusing instructions. A rush of saline solution spilled on the floor. This deflated a tiny bag that had been lodged in my bladder acting as an anchor. I started to pull slowly. Paula was following the action with her eyes. After about a foot of tubing, I could see by her mute expression that she could take it no more, so with one final yank, I disengaged the apparatus. I was free, but I was completely incontinent.
I would regain some urinary control in the next few weeks, but the final male indignity would be left for me. I would find myself, in the mornings, discussing with my wife the efficacy of our pads, which ones worked better for her and which are better for me. This is a level of intimacy, if had a choice, I would have chosen to forego.
After a while, my incontinence became less of a problem. However, my ability to sexually function was no longer a viable option. I was no longer able to get an erection sufficient for sex. I hoped that the surgeon’s so-called “nerve- sparing technique” would enable me to return to normal. Not so! Perhaps it would work for some other guy, some big, hairy, much younger, other guy, but not for me.
Various therapies were tried in the next few months. I endeavored to manually manipulate it. No good. I applied negative pressure to it in a long (well, not so long) plastic tube. No luck.
“What about the testosterone patch?” I asked.
“Counter indicated,” my doctor said.
Herr Frankenstein must have devised the next idea. In order to get the tiny member to rise: Inject it with a hypodermic needle. A tiny diagram that was wrapped in the hypodermic packaging showed just how to hold the little guy and where to insert the needle: off to the side. It hurt like hell but it worked for a while. I was encouraged. My medical plan would pay for the needles. It was a recognized therapy. Perhaps I needed a larger dosage. Back in the doctor’s office, the nurse produced the maximum, most potent formulation. The needle was inserted. Suddenly, then, the room started to get dark.
“Sir, please lie down, sir, your face is white, lie down, put your knees up,” she said.
“Well, what, did it work?” I said, when I regained consciousness.
“No, sir,” she said, indicating that I should remain prone, “your blood pressure went way down, and so did everything else.”
I continued to feel sorry for myself; however, in the waiting room, I noticed a young man, maybe 18 or so, in a wheelchair. He was just a kid. This was tragic. At least I had a pretty good run at it in my time. I hoped he would be successful and that his example would give me some perspective into my own problem. It didn’t.
* * *
I had had enough. I needed to think and reevaluate. If I couldn’t change my condition, could I change the way I thought about it? I did some research. I read that sexual relations were a matter of the heart and mind. I had been preoccupied with only the mechanical aspects. I also found something else.
“Honey,” I said one evening after we returned from an early movie. “ I think I found something.”
“What’s that?” she asked.
“The medulla oblongata is the oldest iteration of the human brain.”
“It deals with survival issues, matters of life and death and, of all things, the male orgasm.”
“I thought it was the…you know. So does that mean that even if you still can’t get a, well, you know, you can still have an…, is that right?”
“Well, then, maybe we should, you know. There is one more thing that we just haven’t tried yet.” She took my hand and led me into our bedroom.
The next morning, we both slept late. Bailey, the dog, left us alone. The sun was strong. It felt good. I didn’t feel like damaged goods anymore, and I was grateful as hell to her. It all worked out just fine, for both of us.
Ralph Gilbert is happy to receive reader comments and questions. Just post them as comments below and he'll answer them here.
This program aired on October 26, 2010. The audio for this program is not available.
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