Saturday
Then: Puppet Doctor
For a long time after my diagnosis, through surgery and even for more than a year after surgery I put the blame for nearly clamping me in a death noose on my general practitioner of 20 years, whom I’ll call Lt. Dan (his real first name). That’s mostly gone now. In rank order of blame, I would say they are: 1.) outside forces and events that I let control me negatively; 2.) inside ‘guyness’ and laziness that kept me oblivious to the obvious; 3.) modern medicine as practiced by the Cowhage Clinic; and finally Lt. Dan.
(I’ve changed the doctor’s name to Lieutenant Dan, who was the Gary Sinese character in Forrest Gump. He was a fellow who was not his own man, but instead was merely an icon for his family’s destiny of doom. I’ve changed the name of Dan’s corporate medical practice to Cowhage, which is a “vine with crooked pods covered with barbed hairs that cause severe itching.”)
The outside forces I refer to are mentioned throughout this book, but poor diet and nutrition, especially high fat foods definitely played their nasty role. My guyness and laziness showed in my complaining about symptoms for more than two years – frequency and urgency to urinate. And I now recall both my father and Carla asking on occasion if I had gotten a PSA during annual physicals, with my reply being: “I’m sure of it.” Actually, I had no idea what they were talking about.
And then there’s modern medicine. I sometimes think it is run by actuaries at the health providers. The National Cancer institute recommends that men with any family history of prostate cancer get annual PSA tests starting at age 40. For other men, symptoms such as frequent urination should trigger the test. All other men should get tested starting at age 50.
My first PSA test was at age 51 and this came after three years of running to the bathroom every 15 minutes whenever drinking anything and getting up in the night six times. The year earlier, in 2000, after Lt. Dan did a digital exam of my prostate, he listened to my complaint about my symptoms, but did not mention the PSA test.
So why did Lt. Dan wait until 2001 -- three years after I first complained of symptoms -- to nonchalantly add a PSA test to the digital exam, which he followed with these words: “It feels like last year. It’s enlarged but that happens with age. But it feels smooth. I’ve felt prostates with cancer, and yours doesn’t feel that way at all.”
This is pure speculation, but I suspect Lt. Dan’s large corporate practice has a policy of pushing the NCI guidelines so as to save money. A naïve view? Maybe. I'll likely never get at the truth of why my horrid doctor let me almost die, but perhaps my tale will put other guys on the path of "outing" their puppet doctors.
I’m still galled that when Lt. Dan called me following my exam, he started the conversation by talking about a blood test for an enzyme that he thought might be causing lower leg pain. He said the enzyme was slightly out of the normal range, but not worrisome, and that the pain should subside. I’m of course just listening along to this blather thinking: “Ok, that doesn’t sound too bad.” I wasn’t even wondering about the PSA test because he had added it to my exam with such nonchalance. Then he said: “But your PSA is over 140. And I’ve arranged for you to see Dr. Bill Utz tomorrow.” Stupid me, I didn’t even think 140 was alarming because I hadn’t a clue about the scale and normal range. Lt. Dan added that it could be an infection, and the conversation was over.
Of course, the next day when I bent over for Dr. Utz, his digits immediately picked up troubling fissures on the moonscape. So I’ve spouted off to others many times since then: What a dolt! How could this shoddy general practitioner count on his wooden puppet fingers as his primary barometer of prostate health? And why was he so damn timid in delivering the bad news?
I only saw Lt. Dan once more when I ran into him in the hospital corridor following tests on the awful December 27, 2001. He’d gotten some word from Utz about what was going on. I went up to him and said, cheerfully: “Well, it’s pretty good news. It is stage T3 outside the capsule of the prostate and in the seminal vesicles, but my scans were negative.” I think I confused him with my tone about the grim news, because he just looked at me like an expressionless dolt. Then he said something like: “Well, that’s good, I guess. It could have been worse.” ¶ 1:57 PM
(I’ve changed the doctor’s name to Lieutenant Dan, who was the Gary Sinese character in Forrest Gump. He was a fellow who was not his own man, but instead was merely an icon for his family’s destiny of doom. I’ve changed the name of Dan’s corporate medical practice to Cowhage, which is a “vine with crooked pods covered with barbed hairs that cause severe itching.”)
The outside forces I refer to are mentioned throughout this book, but poor diet and nutrition, especially high fat foods definitely played their nasty role. My guyness and laziness showed in my complaining about symptoms for more than two years – frequency and urgency to urinate. And I now recall both my father and Carla asking on occasion if I had gotten a PSA during annual physicals, with my reply being: “I’m sure of it.” Actually, I had no idea what they were talking about.
And then there’s modern medicine. I sometimes think it is run by actuaries at the health providers. The National Cancer institute recommends that men with any family history of prostate cancer get annual PSA tests starting at age 40. For other men, symptoms such as frequent urination should trigger the test. All other men should get tested starting at age 50.
My first PSA test was at age 51 and this came after three years of running to the bathroom every 15 minutes whenever drinking anything and getting up in the night six times. The year earlier, in 2000, after Lt. Dan did a digital exam of my prostate, he listened to my complaint about my symptoms, but did not mention the PSA test.
So why did Lt. Dan wait until 2001 -- three years after I first complained of symptoms -- to nonchalantly add a PSA test to the digital exam, which he followed with these words: “It feels like last year. It’s enlarged but that happens with age. But it feels smooth. I’ve felt prostates with cancer, and yours doesn’t feel that way at all.”
This is pure speculation, but I suspect Lt. Dan’s large corporate practice has a policy of pushing the NCI guidelines so as to save money. A naïve view? Maybe. I'll likely never get at the truth of why my horrid doctor let me almost die, but perhaps my tale will put other guys on the path of "outing" their puppet doctors.
I’m still galled that when Lt. Dan called me following my exam, he started the conversation by talking about a blood test for an enzyme that he thought might be causing lower leg pain. He said the enzyme was slightly out of the normal range, but not worrisome, and that the pain should subside. I’m of course just listening along to this blather thinking: “Ok, that doesn’t sound too bad.” I wasn’t even wondering about the PSA test because he had added it to my exam with such nonchalance. Then he said: “But your PSA is over 140. And I’ve arranged for you to see Dr. Bill Utz tomorrow.” Stupid me, I didn’t even think 140 was alarming because I hadn’t a clue about the scale and normal range. Lt. Dan added that it could be an infection, and the conversation was over.
Of course, the next day when I bent over for Dr. Utz, his digits immediately picked up troubling fissures on the moonscape. So I’ve spouted off to others many times since then: What a dolt! How could this shoddy general practitioner count on his wooden puppet fingers as his primary barometer of prostate health? And why was he so damn timid in delivering the bad news?
I only saw Lt. Dan once more when I ran into him in the hospital corridor following tests on the awful December 27, 2001. He’d gotten some word from Utz about what was going on. I went up to him and said, cheerfully: “Well, it’s pretty good news. It is stage T3 outside the capsule of the prostate and in the seminal vesicles, but my scans were negative.” I think I confused him with my tone about the grim news, because he just looked at me like an expressionless dolt. Then he said something like: “Well, that’s good, I guess. It could have been worse.” ¶ 1:57 PM
