How it all began: Part 1
It all began simply enough. I was in the local doctors surgery for a checkup. Just the normal things, heart and blood pressure and general health.
The doctor took my blood pressure and seemed happy with the result. He inquired about my general health and then said "Have you had a PSA blood test to check your prostate?" The question sent my mind in a direction I hadn't even considered as a health issue, and a hesitant "no" was the reply.
The doctor explained that PSA stood for Prostate specific antigen and is a blood test that can help diagnose prostate disease.
" Well I think it might be a good idea " was his reply, and he proceeded to write out a form and handed it to me. The form was a request to the local Clinpath Pathology clinic at the medical centre to have a blood sample taken.
I arrived early at the medical centre on the following Saturday morning. Three people had already arrived and were waiting for the doors to open. At 8am sharp the doors were opened and the three quickly proceeded to the blood clinic, seemingly intent on getting this little distraction out of the way tackling the days activities.
A registration book had to signed just to ensure no one jumped the queue. After about fifteen minutes I was called in and after presenting my form the nurse went about her routine. I had to spell my name and state my date of birth, which was repeated back to me. The label was then placed on a small tube There had obviously been a mix up somewhere and it was now routine at all clinics to follow this procedure.
Having seen to the preliminaries, the nurse then turned her attention to the job at hand. She opened a new syringe from its packet took and then asked me which arm I preferred to have the blood taken from. Having settled that question, she then gave my arm a couple of taps to find my vein and withdrew the required amount of blood. The nurse then quickly cleaned the area with a alcohol placed a cotton ball swab on the needle site, and applied some protective tape. She then asked me to repeat my name and date of birth and having satisfied herself the information was correct attached the label to the tube of blood I was free to leave.
I made another appointment at the reception desk to see the doctor in a week. In the meantime the Pathology laboratory had tested the sample and had returned the result to the doctor. The news wasn't what I was expecting.The doctor explained that PSA means Prostate specific Antigen and it is a protein which is secreted into the ejaculate fluid by a healthy prostate. In a healthy prostate only small amount is allowed to enter the bloodstream, however if cancer is present more PSA is able to leak into the bloodstream and a raised level of the protein can indicate the presence of cancer. I was told the blood test had shown an elevated level of PSA and according to the scale that the medical world used as a guide would refer me to a Urologist. He then wrote a letter of referral and after thanking him I left.
The letter was to a Dr Stapleton at Calvary Hospital. I went home and made the appointment. I had a three week wait.
Calvary Hospital is one of the oldest in the state having been established in 1900 by the Sisters of the Little Company of Mary. In May 2006 the hospital became known as Little Company of Mary Health Care and today is a acute care facility with 180 beds including a Hospice.
The Urologist
The Urologist's consulting room was one of many rooms which ran off a long corridor. It was typical of doctors' waiting rooms. There were both men and women seated, waiting their turn for appointments. The usual supply of books and magazines were available to fill in the time, and two receptionists busied themselves with the daily activities of answering phones, making appointments and collecting patient files. This routine was broken by the occasional appearance of the urologist himself, escorting the last patient back to the reception desk and calling the next patient.
My first impression of Dr Stapleton was good. He was a man in his mid to late forties, average height, fit looking, with greying hair. He seemed to have a pleasant personality, and moved purposefully, as if time was important.
One by one the patients had their turn and left and finally the doctor appeared, and called my name.
We shook hands and he ushered me into his consulting rooms and we sat down. My first impressions seemed confirmed.He opened a folder on his desk which appeared be my medical notes. The file looked thin. He asked me about the events leading up to my appointment with him, and scribbled notes while I talked.
The urologist then in a very business like manner described how the PSA Blood test was a first step used to alert doctors to the possibility of prostate cancer, and then very calmly told me he would do a physical examination of my prostate. He asked me to lay on a nearby bed. As he was putting on a pair of latex gloves I contemplated fleeing from his office. I figured if I could just make it to the front doors of the hospital I was away free. I felt like a rabbit caught in the headlights. I didn't ask for a second opinion nor ask him to check his work.
Dressed and back in my right mind, and sitting once again at his desk like a naughty schoolboy, the urologist said I had some enlargement of the prostate but that it was normal as men got older.. He asked me whether I had difficulty passing urine or any associated problems to which I hadn't, and that it was a surprise to me to even be in his consulting rooms. He then told me it was a silent killer, among men which helped incredibly with my increasingly anxious thoughts.
The Urologist told me that infections can also cause the prostate to register higher on the prostate Richter scale or whatever they name it, and he prescribed a course of antibiotics and wrote a referral for another blood test three months hence.
I said thankyou very much and was escorted back to the receptionist who arranged another appointment with the Urologist and having parted with the money for the appointment fled the hospital.
I did wonder on my way back to work how many rectums he had felt that day and whether he avoided talking about it at the meal table.
Life returned to normal for the next three months and I dutifully took my course of antibiotics,and in time returned to the local medical clinic for another jab blood test.
My next appointment followed the procedure of the first visit, and it was at this appointment the urologist told me the PSA levels had risen and that a he was going to send me for a biopsy of the prostate.
I felt somewhat relieved at this news as I had feared another trip to his couch, and the thought of him putting on those rubber gloves again cause some disquiet in my mind.
So another appointment was made this time to have the biopsy. I was told this would be done at the hospital and that I would be under aesthetic and asleep when this was done. For this I was somewhat grateful as I didn't want to witness a crowd putting a probe where the sun doesn't shine in order to reach the prostate.
I arrived at the appointed time and reported to the receptionist, and was told to take a seat in the general waiting room. A constant stream of people entered and exited and there was the usual waiting time.
Finally my name was called and I was escorted into a cubicle and asked to undress and don a white hospital gown., and to leave my clothes and belongings in a paper bag.
For what seemed like ages I struggled with the gown in this tiny cubicle. Initially I couldn't fathom out how to put it on, and at one stage had it on back to front. When I looked down the gown gaped open, and I quickly realised that the last thing the hospital needed was someone fleeing the hospital screaming and in a state of shock.. When reversed it and put my arms into it the gown slid off my shoulders with a mind of it's own, and a breeze at the back told me not all was right. If I emerged like that someone would die laughing and I didn't want to be responsible for someone's early demise..
It was with great relief I found a couple of ties and quickly attempted to tie the gown up so some decency prevailed. Finally I sheepishly emerged, sure that half the hospital would be waiting anxiously to see if I had perished inside the cubicle.
I sat down with others who had gone through the same procedure, thinking that women must found this much easier than men. I sat there trying to be calm but my blood pressure was rising.
Finally I was called and escorted into the operating theatre and asked to lie down on the bed which was performed clumsily with some indignity, as the bed was higher than normal. I don't remember much after that. I don't particularly want to know but I suspect I was strung up like a chicken and a probe placed inside my rectum guided by a camera. The probe takes a small piece of the prostate tissue which is sent to a pathologist for analysis and the results sent to the Urologist.
When I woke up I was in a room by myself and was left while the effects of the analgesic wore off. I was then asked to get dressed and report back to the receptionist for further appointments with the Urologist. I left the hospital feeling I had been raped by a gang of marauding camel drvers.
The verdict
I made the necessary appointment to see the urologist the following week and went through the same waiting room procedure being summoned by the Urologist. We greeted each other again, shook hands, and I sat down in front of his desk.
The urologist said he had received the pathology test back and in his usual no nonsense style announced the news. I had prostate cancer. The news stunned me, but he now had my full attention
The doctor then sought to reassure me that this was far from a death sentence and that there was much that the medical world could do. At this stage he outlined the various treatments that were available to me.
One of the options was to undergo surgery to remove the prostate.He outlined to me that if the cancer was contained in the prostate he would perform what was called " A radical nerve sparing prostatectomy"
He went on to explain that this involved removing the prostate, which is the central business district of a a mans sexual function and involves removing the ability to produce semen and sperm and a cutting and rejoining of the urinary tract, and associated nerves. Erections following the operation would return in the majoritory of cases in the fullness of time. There would be some urine incontinence for a time but that would improve with pelvic floor exercises, and finally cease altogether in most cases.
The other options included radiotherapy, chemotherapy, or " seeding " the prostate a procedure where radioisotopes are seeded into the prostate cancer area.
He went on to explain that he specialised in the open surgery where they enter through the lower abdomen to remove the prostate. He told me that this was his specialty and his success rate was high. I was somewhat relieved. It was the first sign of any good news that day.
He asked me to go away, research the options, or get second opinions if required, and report back to him
In the meantime he would send me for a bone and CT scan. I left the hospital in somewhat of a fog, but somehow relayed the news to my supervisor at work who was anxious for the results. I also rang my wife. I don't remember the drive home.
The appointment for the bone and CT scans was scheduled for 2 weeks time and in the meantime I read all the literature the urologist had given me. It didn't take me long to decide on the " nerve sparing prostatectomy " operation. It seemed to me at the time that if they took the prostate out then there could be no doubt as to the cancer still being present.
It wasn't until I was sitting in the waiting room for my bone scan that it suddenly occurred to me that the very reason I was having the bone and CT scans was to eliminate the possibility that the cancer might have spread into my bone or other parts of my body. The thought chilled me. What if? I thought.
A bone scan is a nuclear scanning test to find abnormalities in bone.
I must have been deep in thought because I didn't hear my name being called. It wasn't until somewhere in the distance I heard my name called and looked up to see a nurse with a clipboard and a puzzled look. I answered to my name and was ushered into a room by the nurse. I was then asked to lie down on a table and remain very still while the table slid under the scanner. There was no request to remove any clothing or to put on the dreaded white gown.
The scanning process took only a few minutes and I was free to go. I returned to the waiting room eager to breeze through the next scan and return to work. I know now why they call these rooms waiting rooms.
Finally after about 40 minutes my name was called and I followed the nurse already thinking of the drive back to work. My hopes were dashed when she took me to a small cubicle and asked me to get undressed and to put on the dreaded white gown and to wait in a small room adjacent to the cubicle. Reluntantly I went through the same process as before but this time I was a little wiser and managed to emerge after just a few minutes gown in tact and a semblance of humour starting to return.
Why? I thought to myself do I have to get undressed for one scan and not the other? I resigned myself to the fact that they were different scans and required different methods. Finally having had the scan and dressed again I removed myself quickly, got into my car and returned to work with tales of woe at hospital routine.
My next appointment with the Urologist was scheduled for the following week. Again I went through the routines of the waiting room, sometimes reading, sometimes just watching the daily activities of the receptionists, but all the time waiting. This routine would be broken every so often with the appearance of Dr Stapleton escorting his last patient back to the receptionists and calling the next.
After what seemed hours Dr Stapleton appeared and called my name. We shook hands again and I followed him to his consulting room and sat down.
For the first time the gravity of the situation really hit home. I had heard that bone cancer had its own fearsome reputation, and two of my friends had died after battling this disease. I could feel the anxiety rising within me, and my heart beat seem to rise with every thought. I felt like a prisoner facing a judge, and waiting for his verdict. Was this going to be the start of the end of my life? I braced myself for the verdict.
"Well Ian "said the urologist, " I have some good news. There is no evidence of any cancer outside of the prostate" The news took a few seconds to wash over me. I nodded silently in acknowledgement, the gravity of what might have been causing tears of relief to well up. I had dodged a bullet. A reprieve had been granted.
The discussion quickly turned to my decision on treatment. I had decided to trust myself to his skills and advised him that I would have the operation to remove the prostate. He seemed please with the decision.
The operation was planned for the July of that year. I had two months to wait.
In the meantime men facing the operation were encouraged, along with their wives, or partners to attend a pre-operation information evening for men facing prostate surgery, and what to expect following their surgery. This was to be held at the hospital. My wife and I arrived about 15 minutes prior to the scheduled start and waited in the entrance foyer of the hospital.
After about a 5 minute wait in the near deserted foyer another couple arrived and we exchanged greetings and we confirmed that we they were there the same reason..
We were distracted in our chat by a woman in her late 20's who appeared on the scene, carrying several large bags,. The woman came over to our small gathering and introduced herself as Sharon, apologised for running late, and asked us to follow her.
We followed Sharon quickly down a corridor, and through a open courtyard to a old building in darkness.
Sharon stood at the entrance and fumbled with a bunch of keys in one of her bags and after several attempts found the right one and opened the door. Once inside the lights were switched on, we were shown into a large room obviously used for meetings and seminars. "This was supposed to be set up for me" Sharon exclaimed as she unburdened herself of her bags. "Where is the laptop and projector?" Somehow there had been a breakdown in communications, and nothing had been prepared. Sharon it appeared was doing this on a voluntary basis,and had come straight from her shift in the hospital. I felt sorry for her, but without cursing at her misfortune, she gathered herself in a very professional way as if used to having hurdles presented in the way, and asked the group to make themselves comfortable while she went and hunted down a computer and projector.
In the meantime small groups began to find their way to the meeting. Sharon returned carrying the required laptop and projector and busied herself setting up the equipment, without fuss or bother.
The bags she had been carrying now gave up their secrets. She unpacked an assortment of medical paraphernalia and laid them on nearby table. My enthusiasm for the evenings entertainment started to take a dive.I began to realize these were to become very familiar to me in the coming months.
Eventually the gathering was called to order and Sharon introduced herself and explained that this was to be her last information night for awhile as she was pregnant and expecting their first child and that she was handing over to another colleague. I felt relieved that an experienced person was giving the seminar.
For the next hour Sharon explained the intent of the meeting. Men she said had no idea what to expect when they come into a hospital for a prostate operation Sharon had asked the hospitals' permission to start up a information night.
For the next hour we were given a insight into what to expect following our operations. The room fell silent as the reality of what were about to receive was explained.
The central business district of a man's sexual plumbing system was talked about as if we were talking about the weather. Sharon explained that as a high care urology nurse she had seen it all. Nothing could shock her. Catheters, catheter bags,overnight drainage bags, tubes, and an assortment of incontinent pads of all sizes were produced in order. Demonstration followed demonstration, question was followed by question and more demonstrations. My mind was racing, and I could feel the tension in the room as a group of men were faced for the first time with sobering facts they were about to encounter.
After about an hour and a half the meeting came to a close and gradually the groups left the building and quietly disbanded. Outside, the darkness and chill air, reflected the mood.
The weeks passed quickly with the routines of working and domestic life, but the red circle around July 14th on the kitchen calender was a constant reminder of the coming hospital stay.
Part 1 End
