There is no really great time to be told you have cancer. But this was really inconvenient. I get my physical every year around my birthday so I'll remember to do it. Who likes to think about upkeep, right? My doctor's name is actually Miles Davis. I love that he's never heard of the other one. I think he looks forward to seeing me each year. He's intrigued and I think maybe a little envious of the creative field in which I teach. He bemoans the state of medicine in America. That new students are so dependent on technology that none of them know how to use a stethoscope. He confides to me that nobody better get sick in the future. All this as he presses and probes and peers and palpitates.
He takes off the stethoscope, and I try to monitor my heart as I wait for the verdict. It's all about the heart for me. My father's went at age forty-eight. His father's and brothers' didn't last much longer. Which is why I stay away from red meat and tobacco and play some semblance of tennis... All the paper umbrellas we hold up against the thousand-ton safe that's falling at us from some indeterminate distance. Davis knows what I want to hear and goes straight to it.
Your heart sounds good, he says. Blood pressure's good. Your weight hasn't changed in the year. I like that. Neither has your height. Same lame joke every year. But I give him the laugh. Because if he's joking it means that he hasn't found anything!!!!!! The warrantee is still in effect. I've gone unnoticed. Slipped under the radar.
I have literally one foot out Dr Miles Davis's door when he Columbos me. Remember the Peter Falk detective? Just when the killer thinks he's outwitted him, Columbo asks one innocuous question that crumbles his entire fabric of lies.
Dr. Davis's question was..."Say, when was the last time we checked your prostate?." I mumble something about probably last year. He looks at his chart. Says, "No, it's been two. Why don't we do a digital?"
When Dr Davis suggests a "digital exam" he is not referring to an examination of the digits but an examination by the digits into an area beyond the digits' easy reach. He puts on the rubber glove as I drop my pants and take the position. He slides his lubricated finger up as far as it will go. It's like when you were a kid and you dropped a quarter down a sewer grate.
- I feel a roughness on one side, he says and the world starts to spin.
- Was this ever here before?
- "How the hell should I know!" I snap at him. But he knows and I know. It wasn't there. He sees the blood leaving my face.
"Your prostate is small," he says. "That's good." He's working hard to tread the fissure between optimism and alarm. "Let's not get too concerned until we see the result of the PSA test."
At this moment in my life I am so colossally ignorant of my body that I have never heard of Prostate Specific Antigen. PSA still means Public Service Announcement. Or Poetry Society of America. At home I do nothing to spackle in the cracks of my knowledge. Ignorance becomes my shield. I knew I should have followed my grandfather's advice about not going to doctors. "Vat...they'll look they'll find."
And indeed, when Davis calls the following day with the results there's no small talk. Harold your PSA has come back at 11.8. I strain to hear relief in his voice. Is he saying, "We were worried there for a minute but whew it's just 11.8. Or is he telling me life is about to get nasty? I ask him what's normal, and gird myself to hear a number like seven or eight.
- "For your age anywhere between two and three. Above four we'd be a little concerned."
- "Do I have cancer?" The words fell out of my like mouth like a bad dream about teeth.
- "We're jumping way ahead of ourselves. I'm going to give you the name of a urologist to call. Let's calm down till we get the results of a biopsy.
If you're anything like me, you find the prospect an impending biopsy to be incredibly soothing. Seriously. If I ever have trouble sleeping I schedule a biopsy just for the calming effect it has.
The four other men in the waiting room are there with their wives. They're much older than I am. At least they look older. At least I hope they look older. One of the women smoothes her husband's collar. Another one points out a picture in a magazine they both seem to recognize. I feel noble being here alone. I don't need anyone to be my damn buffer.
The nurse takes me into an examination room. She reads a litany of questions from a clipboard.
-Lack of sleep?
-Sleep all the time?
-"It would be a drag to have both at the same time."
She gives me the look I've been getting all my life.
-Difficulty in starting urination?
-Dribbling after urination?
-"Do you really need to now this?"
-Inability to get erection?
-"Sounds like an interview for a first date."
I'm just trying to diversify her day. I guess she doesn't take it that way.
-Doctor Fitch will be right in", she says and exits without mirth.
Left alone, I snoop around the office. The shelves are laden with the tools of the trade; rubber gloves, finger condoms, KY jelly. Why does someone become a urologist? Is he too shy to be a gynecologist? Does he come to his office every day through the Great Hall of Urology, the walls lined with portraits of the immortals? The inventor of the urinary laparoscope, the flexible catheter...? There's his diploma. 1979. He must have squeezed 30,000 prostates in his career. I wonder if he remembers them all? Like men remember every breast we've stroked.
I'm startled when Dr Fitch comes in through another door. He is armed with a needle the size of an elephant gun. And nods for me to take the all-too-familiar position. Pants dropped, Knees bent. Forehead against the wall. For those who never have had the pleasure of a prostate biopsy, picture a bratwurst on a barbecue grill. Now picture a spring-loaded SKEWER jabbing through its skin to see if its juices spatter. Think of this happening twelve times. Now think where that bratwurst is. Still that's better than what happens next. Sitting across the desk from him, Dr. Fitch looks me nearly in the eye as he has been taught by his Patient Relations seminar, and as if he were breaking this news for the first time in his life, says eleven words I am not likely ever to forget.
"Well, Mister Ackerman, you've got quite a bit of cancer there. He goes on. Cancer of nine of the twelve cores. Your Gleason score is seven, five being the least aggressive cancer, eight being serious cancer. This cancer is treatable. If you had to get any kind of cancer this is the best kind of cancer to get."
I wonder if he could say 'cancer' a few more fucking times. But I'm not worried. I know in a moment his nurse is going to burst back into the room all flustered, waving the fax she's just received from the lab, apologizing for mixing up the results: "Dear Recent Biopsian...Boy are our faces red. It's not you, but some other poor bastard who has to face his mortality. We regret any inconvenience this may have caused, and hope you'll continue to think of us for all your cancer-screening needs."
Surprisingly this does not happen. While I've been zoned out, Dr. Fitch has been droning on about statistics.
-Every year 200,000 men get newly diagnosed with it and 30,000 men Die. We haven't determined the cause but we do know that the chances of getting increase with age. For a man in his 40's, the odds are one in 50,000. At 60, it's one in 500.
At your age, the chances are one in a thousand. So what do we do about it? Most men elect surgery-Just cut it out and throw it away. We can schedule the procedure right now if you'd like.
"No! I have to go home and make dinner."
-Radiation is another option. We've scheduled a bone scan.
"Can't I just come back in a few days?"
He practically has to grab me by the shoulders to get me to hear.
"Mr. Ackerman. With your numbers there's an even chance the cancer has already spread? Take the elevator down three levels and follow the signs."
The sub-sub-sub-basement is like a bomb shelter. Thick concrete walls. All painted orange. In a blind trance of obedience, I follow rather than flee the signs pointing to NUCLEAR MEDICINE. I feel like my ancestors going willingly to the ovens. In the deepest part of the dungeon I am met by a lab technician who shoves me up against a cold flat slab of glass then wisely stands behind a wall of sandbags and throws the switch sending thousands of Roentgens pulsing through my body. The prints come out of the machine and it looks like Van Gogh's "Starry Starry Night. "What is all that" I croak.
-The migration patterns of prostate cancer are as predictable as Ospreys. They seek out the femur, the rib cage. Their vacation islands of the Pacific. I'm seeing a lot of hotspots.
"Is this what I think it is?"
Dr. Fitch will call in a few days with the results.
But I don't need to hear it from him. I've seen the glowing constellations all over my body. I'm about to be one of the thirty thousand.
It is 5:30 of an early December afternoon when I returned to the outside world. Everything looks alien, like I have been to another galaxy and returned a hundred years later. The sky is cobalt blue with streaks of orange and I have cancer. People walk across the promenade talking about real estate prices making dinner plans and I have cancer. Their kids run before them, erratic and thoughtless and I have cancer? Do they shield their kids from me? Am I marked? Can they tell I have cancer? I remember being that age, walking down Ocean Parkway in Brooklyn on nights like this. --The streets filled with men coming home from work, wearing overcoats, carrying brief cases filled with adult concerns. I wish I could be child again among them, comfortably invisible, a loaf of warm bakery rye bread under my jacket, cool fresh air with the smell of burning leaves in my nose, knowing that when I get home there will be a hot bowl of soup waiting for me.
I drive homeward and try to keep the future inflated in front of me. But it keeps collapsing as though I had inhaled a plastic bag. I see mental images of that second group of X-rays dotted with pulsating points of light. Hot spots. Metastasis. Galaxies of disease. I put a Tom Waits song on that has a repeating refrain, "hold on, hold on, babe you got to hold on." I put it on replay, and I hold on for dear life.
Hal Ackerman co-chairs the UCLA screenwriting program. His fiction and poetry has been published in several literary journals. He two "Soft-boiled" murder mystery novels out: Stein, Stoned and Stein, Stung. "How Prostate Cancer Made a Man of Me" is an excerpt from a longer prose piece that eventually evolved into a play that won the William Saroyan Centennial award for drama, and later won the Best Play award at the New York Solo Festival as a one-man play.