I’d been meaning to wash my car for days, and was pleased to see I had just enough time to fit that little task in before sunset. Just as I’d finished and hopped into the driver’s seat to move the car back into the garage, my cell phone rang. It was my urologist, Dr G. As he started to speak, in that first instant, 2 thoughts flashed through my mind: First, when the doctor’s office calls, it’s always a nurse or administrative person, not the doctor himself. And second, they don’t call after office hours—probably 4:45 at the latest. It was 6:30. This was odd. After a pleasant hello, the conversation began like this:
Dr G: I just got back the results of your prostate biopsy from the lab, and I’m sorry to tell you, you have prostate cancer.
Me: Um, uh, okay...
Dr G: It was a Gleason 7—a 4 plus 3.
Me: Gleason 7? What’s that? Is it bad?
Dr G: Well, it’s not the worst...
Dr G then explained that he’d submitted orders for additional tests, and that the next day I should call to set up a session with the counselor, and to make appointments for a CT scan and a bone scan. I repeated this brief checklist, assured him I’d make the calls, and hung up so that he could wrap up his long day and go home. It all seemed straightforward enough at the time, just a couple of things to take care of tomorrow, and then we’ll go from there. In a strange way, I almost felt relief. This dreaded disease that had killed my dad, that I’d feared all my adult life, finally I no longer had to worry about getting it—because I had it. Like a bully who keeps threatening to beat you up, the wait was over, the fight was on. And in my corner I had decades of technology and cutting-edge medicine, as well as my doctor, who spoke confidently and who clearly had a plan to take it on. “Alright, I’ve got cancer,” I thought, “and now I’ll deal with it.”
But as soon as I hung up, questions and doubts and panic started filling my mind. “Wait, I’m seeing a counselor? Why a counselor? Does everyone get sent to a counselor? How bad is this?! Okay, it’s ‘not the worst,’ but... What the heck is a Gleason 7? And what’s a CT scan? Is that the same as a CAT scan? I’ve heard of a CAT scan... (Hmmm, actually, I don’t really know what a CAT scan is either...) And a bone scan? Bone scan, bone scan, BONE SCAN?! Oh God, that can only mean one thing, the cancer is in my bones! Can they fix it in my bones?” And suddenly, after a few scant moments of this runaway internal dialogue, I’d convinced myself there was no doubt: I was going to die. In 30 seconds I’d gone from triumph to death! But it soon toggled back to optimism, and mostly stayed there.
I did beat myself up with one question: Why did I wait so long to get another PSA test?! I would have been a lot more confident about what these upcoming scans were going to show had I been diagnosed a year sooner. Sure, I was busy. Everyone is busy, but how could I let something so important slip for so long when I knew my risk factors? Was it just bad prioritizing? Had I deliberately avoided the follow-up PSA, maybe in some way not wanting to get the result (as if nothing could be wrong as long as I didn’t know about it)? If so, bad strategy! But I think mainly I just wasn’t all that concerned. I didn’t really believe I could get prostate cancer, what with my excellent health and at my age (58). Like everyone else, I pretty much thought that prostate cancer only happened to older men—and besides that, it was no big deal regardless, because we guys always hear that if we live long enough everyone gets it and something else will kill us first anyway, so no need to be too concerned. Who knew that prostate cancer also comes in an aggressive, life-threatening version? Not me. So it had been 2 full years since my first PSA, which itself was borderline suspicious (a 3.3), yet I’d barely given it another thought. I was only tested because my seasonal allergies were acting up (completely unrelated—the cancer had absolutely no symptoms, but the allergies got me in for a doctor visit). Turns out my primary care physician had retired, and his successor wanted to run a set of tests for a current baseline on some things, including a PSA test. When it came back at 11.2, he knew that this big jump up from my previous result was a serious red flag. (And as an aside, now whenever I read an article criticizing the PSA test for its fallibilities, I shake my head. I understand it’s not perfect, but it’s one simple and useful tool available to us, especially to get that starting-point result for future comparisons. So aren’t we better off having that piece of data? There are a lot of men who believe the PSA test helped save their life, and I’m among them.)
When I learned of the cancer diagnosis, my wife and I already had a long-awaited 10-day trip to England planned. Although I couldn’t go in for the bone scan before we left, Dr G assured me that the trip wouldn’t affect an ultimate surgery date, so off we went. And I, a compulsive worrier, somehow managed to enjoy myself and not worry. How? Until I was asked to write this article, I hadn’t really thought about whether my surprisingly positive outlook had been influenced by the way the news was delivered. And I started to wonder, how do doctors decide exactly what to say? There’s surely no “one size fits all”—that is, every patient and situation must be different. Personally, I wanted straight answers, no unnecessary grim details to ponder, and a little reassurance.
A doctor friend once told me that even if he has bad news, he always starts by saying he has good news. This might work for him, because he honestly sees the bright side, but it seems to me that the brief high expectation would invite disappointment. I see the benefit in being positive, reassuring a patient who’s overly concerned, and certainly not painting an overly bleak picture, but I think that people generally want to keep their expectations under control, and hope things will turn out better than expected.
In my case, I don’t know if Dr G’s seemingly candid response that a Gleason 7 is “not the worst” was off the top of his head, but as I reflect on it now it was maybe the perfect answer for me: It at once conveyed that this was a serious thing, but also I figured if I worked and battled it through, I’d come out alright. I’m reminded of a Mark Twain quote, “Eat a live frog first thing in the morning and nothing worse will happen to you the rest of the day.” Dr G’s calling me that night with the diagnosis and a plan for the next steps helped me stay calm and optimistic in the long run. It seemed completely honest, so I immediately trusted him and felt I was getting the whole truth, no sugar coating, nothing held back that might blindside me later. I’d eaten the frog. And in the next few days as I moved past my initial panic, worry was replaced by its best antidote: positive action. Whatever I needed to do, I was going to do it. And my wife was a huge help, researching and filtering useful information for me. We had a mission.
As difficult as it all was, there were some amazing positives. In my mind, I figured if my bone scan was okay, I would definitely live. And probably for the first time, I felt like that was plenty! I could accept any of the other possible long-term consequences, but I really wanted to live. I suppose this is an experience that can’t readily be simulated—to believe there’s a strong likelihood you’re about to die, and to look at what that means. I still wanted to visit Australia and such, but things like that wouldn’t make the list. What I actually thought about was how my wife was going to miss me, just having me around, making her laugh, walking together, taking road trips, making a salad (she doesn’t like making salads), taking out the recycling, replacing her windshield wipers, feeding the cats, so many things to take care of each day. And my son, I didn’t want him to be sad. I wanted to be there for him, for a long time to come. That’s all that really mattered.
The day after we got back from England, I had that bone scan, the moment of truth. The tech was a middle-aged woman, pleasant, very professional. I chatted nervously. She was nice, but stayed on task, no particular frivolity. After running the scan, she left to take a look at it to determine if the images were clearly readable. When she returned, she told me we were through, that I’d done a good job of staying still, and a physician would read the scan and call me in a few days. I thanked her and started walking down the hallway, then turned to give her a wave goodbye. She waved back and I saw she was smiling, a big, radiant smile. Suddenly I was overwhelmed by the sense that she must have known what the scan showed, and it made her happy. I couldn’t be certain, but I knew in that moment that I was going to live. As I turned and continued down the hall toward the exit door, I started to cry.
Two long days later I received the official word: my bones were indeed clear. In brief retrospect I realized, too, there had been other unintentional previews of my cancer story, which probably helped me to prepare for, and therefore cope with, the news. Even when the nurse called to set up my initial visit with Dr G, I noticed she seemed almost too nice, as if my chart showed something clearly worrisome. Likewise, I could tell from Dr G’s calm delivery of the cancer diagnosis that he felt confident he could remove it. So knowing that I had operable cancer, I began part 2 of my life. These were bonus days, a gift, and I felt so very fortunate and grateful to have them. I’d always thought that our purpose on this planet was to contribute in a positive way to the world around us. Now, much more vividly than before, I felt compelled to be a better person, to do things that mattered, to put myself out there and make a difference. A lot had happened in 3 weeks.