Summer of the Crab

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Kenneth Brigham, associate vice president and director of Emory’s Predictive Health Institute, was 56 years old when he was diagnosed with prostate cancer, a disease that killed his father. During his treatment and healing, he kept a journal of his experience, Hard Bargain: Life lessons from prostate cancer. . .a love story, published by Harpeth House in 2001 and available on Hear Brigham read excerpts from the book.

         If you are a man and you live long enough, you
will have prostate cancer. If you are a woman and you live long enough, someone you love will have prostate cancer. That will continue to be true until someone can figure out why it happens and how to prevent it….
     Because prostate cancer is insidious, it is easy to deny. Men don’t want to know that their PSA* is increasing and don’t have to know for a long time. So, even with such a simple and sensitive blood test for early detection, . . . most of these cancers are discovered too late for a sure cure. Most men, even knowing they are at risk, just don’t get the test, don’t want to know.
     I hope this book will change your mind about that. It is possible to delay dealing with reality, but reality in this case is not static—the reality gets a lot worse with time. And the reality can be dealt with, the tragedy experienced, without losing your sense of humor. Also, crises of this sort can nurture relationships. If there is a single most important lesson here it is that relationships are what you really care about, whether you admit it or not.

Friday, May 10, 1996
I have cancer. . .

     This is harder than I thought it would be. It is not a surprise. My father died of prostate cancer when I was 15. The disease is no stranger. My PSA has been on the rise for over a year. The damn thing was there. I knew it. [My doctor] Jay knew it. One time I said to him, "Why don’t you just take it out?"’
     "You operate on a cancer, not a PSA," Jay said. "We have to find it first."
     So this is not a big surprise. But that doesn’t matter, doesn’t soften the blow of finality, irrevocability. I have cancer. I am not the same person I was 15 minutes ago, before I had cancer.

Monday, May 13
. . .There are four options:

     1) Do nothing. Prostate cancers grow very slowly. I would likely live five years or more even if I did nothing. I am 56 years old now and otherwise in perfect health. I do not want to live five years. I want to live a lot longer than that. [My wife] Arlene agrees. We will do something.
     2) External irradiation. This works. The cure rate is somewhat less than surgery, but it is noninvasive. The incidence of impotence is eventually about the same as with surgery. The radiation treatments virtually always cause inflammation of the bladder and rectum. I hate hearing about all of this, sitting here trying to think objectively about the choices, trying to act as though I am not frightened. I squeeze Arlene’s hands.
     3) Brachytherapy. This is where they implant little radioactive seeds in your prostate gland. It has the great advantage of minimal complications (with this disease, "complications" always mean the two I’s, impotence and incontinence). Brachytherapy has the major disadvantage that the cure is not permanent. The cancer comes back in five or six years. That is far too soon to suit me.
     4) Radical prostatectomy. This is "the operation." Bob Dole had it. Marion Barry had it. Timothy Leary, I suspect, did not have it and he is, right now, dying of prostate cancer on the Internet. Maybe LSD helps. . .
     Everybody has some incontinence for a while. It goes away in 98% of people. Those are pretty good odds. Impotence, inability to have a penile erection, is another matter.
     The nerves that control the blood flow to the penis run right on top of the prostate gland. Those are the nerves critical to the function under discussion. If you cut those nerves, an unaided erection is impossible. . .
     I can image having prostate cancer. I cannot imagine being impotent. Apparently the operation leaves everything else—libido, sensations, even orgasm—intact. How totally weird.
     God drives a hard bargain.

Cancer, even at its most hideous, is only an annoying aside. Tragedy is to grow old unloved and unloving. We will all die. Life is a fatal proposition. Love is more than life and does not recognize mortality.

Monday, May 27, Memorial Day
I spent last week at work telling people that I have cancer. It is exhausting work. Rehearsing repeatedly the history, the therapy, the prognosis, is physically exhausting. I guess it makes you deal with the specifics, expose every possible nuance of the process, but it is exhausting.

Thursday, May 30, post-op day 2
The psychological experience is more important than the physical one. Arlene and I talk about that. Jay says I no longer have cancer, and I believe that to be true. I have a lot of tubes in various natural and man-made orifices. I have a sore belly. But I probably do not have cancer. The hollow space in the middle of my chest seems to have filled. The tendency for my eyes to fill with tears when they meet Arlene’s is gone. Although it makes my belly hurt, I can laugh again. The pain will go away. I trust the laughter will endure.

Wednesday, June 5, home
After any surgery in or around the abdomen, bowel habits assume extreme importance. While I was in the hospital, multiple layers of health care professionals inquired frequently and in salacious detail about bowel habits, carefully distinguishing between gas and the real thing. I felt like a two-year-old in potty training when I finally produced to a standing ovation from the team of white-coated voyeurs.

Wednesday, June 12
Jay pulled the catheter Monday afternoon, and it hurt like hell. The pain didn’t last long. Now, two days later, I am virtually completely incontinent. I must wear those big diaper things all the time and change them frequently. Apparently the duration of the incontinence is unpredictable. It can last a few days to weeks to months. It is better than the catheter, but only just. It is hard to get much done when you are constantly concerned about whether you have wet your pants.

Wednesday, July 9
I wet my pants again without realizing it last evening. We sat in the living room. I was half into my second martini. It hadn’t happened for a while. I was depressed again. The experience triggers an emotional response much larger than the facts deserve. The feelings are helplessness, embarrassment, like a small child. And the latent fear that I am, in fact, still ill. That the cancer is still there somewhere and that the ever-present smell of urine is, as I recall it, the harbinger of a dark fate. Maybe the whole business of medicine is a futile effort to thwart the inevitable. We are, after all, mortal. If I am cured of prostate cancer, I will die of something else. I hope it smells different.

Monday, July 29
     There is this little problem of impotence. There are some other options, but Jay suggests to start with "Farmer Osbon’s Wonderful Erection Machine."
     Jay tells us this story for the truth. It seems that several years ago there was a farmer in Georgia who was impotent. Farmers, at least successful ones, are problem solvers and entrepreneurs, and they are not at all daunted by the mechanics of sex. Breeding farm animals involves an entire armamentarium of procedures, devices, and manipulations of the animal psyche to assure the fruitful marriage of sperm and egg.
     So Farmer Osbon figures that if the penis won’t fill up from the inside, maybe you could inflate it from the outside. He made a big tube with a vacuum pump on one end that could fit over the penis, pump it up with a vacuum, and then keep it up by putting a rubber band around the base of the penis to hold the blood in until you were ready to let it down. He made the device and used it, and it worked.
     Farmer Osbon had two young daughters. He packed up his machine and two daughters and went to a national urologists meeting, set up a booth, and hawked his wares. He wore his farmer overalls. Apparently he and his device were the big urologist joke of the meeting.
     Farmer Osbon is dead now, but his heirs are, undoubtedly, all multimillionaires. The current generation of his device is one of the most popular and successful means of dealing with impotence in the world.

Sunday, August 11
Sex is one of those things that is better done than talked about. Sex is quintessential nonverbal communication. When one tries to put words to the music, dissonance is inevitable. Arlene and I talk sometimes about sex, but mostly without words.
     I find myself now compelled to talk about sex with people whom I hardly know. I have enormous respect for Jay Smith as a urologist, but I hardly know him, and I am acutely uncomfortable discussing my sex life with him. The same goes for his nurse.
     Also, the discussions seem all wrong. The discussions are all about mechanics, which never before seemed an issue to me. If the magic is there the mechanics take care of themselves.
     But not when you whack out those blessed vasomotor nerves. . .

Saturday, July 22, 2000
I entered the new millennium with a PSA of zero, four years out from the surgery. I do not have and will never have prostate cancer. I will die of something else.
     …The blue diamond cured my impotence; that little pill rescued Bob Dole and me from having to choose between celibacy and contrivance. The little blue diamond not only takes care of the technicality but also restores the magic. Bob and I are fortunate to be alive at all, but especially fortunate to be alive now.
     Jay Smith’s colleague is taking care of my incontinence by injecting collagen at critical sites. It is working. I imagine the inside of my bladder neck looking like Julia Roberts’ lips.
     On a lovely Saturday afternoon, Arlene and I drive to Franklin just to be together and enjoy the day. We eat lunch at a quaint old restaurant on Main Street. We order a bottle of champagne, and when the young waiter brings it he says, "This must be a special day."
     "Yes," I reply. "Every day is a special day."


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