Hunting for Hippocrates. Warren J. Stucki
cancer, and accounts for about fifty thousand deaths annually in the United States.
“Unfortunately, one of the jobs we have as urologists, is to try to decide who needs treatment and who might do fine without any treatment. When trying to make this decision, there are two factors that we take into consideration. One is the age of the patient and the other is the grade of the tumor. If you’re eighty-five years of age and have a grade one prostate cancer, I can almost guarantee that it will never bother you in your lifetime. On the other hand, if you’re fifty years of age and have a grade five prostate cancer, I can predict that it will cause you trouble in your lifetime. Howard, let’s apply these criteria to you. You’re a man in your sixties with a high grade tumor. My feeling is that it should be treated.” Moe paused to catch his breath, quickly glancing at Connie. She appeared to be listening intently.
“I agree, Doc. Never been much of a gambler, at least not with my life. How we goin’ to treat it?” Howard asked. Connie had stopped crying, but remained silent.
“In the United States today, there are three major treatments for prostate cancer: surgery, radiation and radiation seeds. They all have their advantages and disadvantages—”
“Sorry to interrupt Doc, but I don’t want no damn radiation. It didn’t do my wife no good. She had breast cancer. And from what I hear, radiation killed half the people in St. George in the sixties and seventies with that goddamn atomic bomb testing.”
“What about radiation seeds?”
“It’s still radiation, isn’t it? I think I’d rather you just cut it out and be done with it,” Howard said flatly, then turned to Connie and added. “What do you think, Connie? You’re the one in the family with the medical training.”
“Dad, I’m a pharmaceutical rep,” Connie protested. “That’s not exactly medical training.”
“But you’re around medicine every day. Considering what happened to your mother, what do you think?”
“Of course, it’s up to you, Dad, but I agree, radiation didn’t seem to help mother, and you’re in relatively good health; I think surgery is the right course for you,” Connie said, then turned to Moe and smiled. “I Ve checked out Dr. Mathis with the other doctors and they consider him the best.”
Moe flushed with embarrassment and hurriedly launched into his speech. “Let me tell you a little bit about the surgery. The incision is made in the midline from just below the belly button to the pubis. Initially, we harvest the lymph nodes around the prostate to make sure not even one cancer cell has escaped, then we remove the entire prostate gland. There is enough give, or play, to the bladder that you can pull the bladder down to make up the distance lost by removing the prostate gland with its portion of the urethra. Then you simply sew the bladder neck back to the transected urethra. There can be a couple side effects to that surgery of which you need to be aware. There is about a fifty to sixty percent chance of becoming impotent. The other potential complication, about a ten to fifteen percent chance of being incontinent. With modern medicine, if either of these occur and you want them corrected, they both can be fixed.”
“Hell, Doc, it doesn’t matter. I’m a widower. I haven’t had a woman in five years.” Howard blurted out, then turned crimson as he remembered Connie was by his side.
Moe lessened the embarrassment by hurrying on. “Also, we often lose a little blood with this surgery, so we encourage patients to donate a couple units of their own blood. That way if you need blood, you will get nobody’s but your own. This is called autologous blood transfusions and makes the odds of getting AIDS or Hepatitis from blood transfusions almost zero. You can only donate one unit a week, and we need two units, so that means we can schedule your surgery in a couple of weeks,” Moe said, his mind starting to drift. Connie, as usual, looked stunning today.
Howard set his jaw. He’d made up his mind. “Let’s go ahead and do it, Doc. The sooner the better.”
“Howard, I almost forgot.” Moe forced his mind back to business. “I can do your surgery two weeks from Tuesday, but the only snag is I’m going on vacation that following Sunday. If we do your surgery then, my partner, Dr. Wright, will be on call in my absence, in case of any emergencies. But, you should be home by then and out of any danger. If you don’t like that idea, we could delay the surgery till I get back. I’ll be gone for ten days.”
“What about recovery time? Will I be able to take care of myself at home?”
“Yes, I’ve done this surgery on single men before, and they’ve done fine at home alone.”
“Well, I can help with his care,” Connie insisted.
“Yes, and we can even have home health nurses come by, if need be. But Howard, it makes no difference to me. We can easily wait till I get back.”
“No Doc, I don’t want to wait. I can almost feel it spreading now. Any little pain, even arthritis, makes me think it’s the cancer. If we’re going to do it, let’s get it done and as soon as possible. I suppose Dr. Wright knows what he’s doing, doesn’t he? I mean, if we need him.”
Moe decided it would be best not to say anything, rather than say what he was thinking. He simply said, “Dr. Wright is a board certified urologist.”
“Doc, this probably sounds silly,” Howard said. “But since I’m going to lose mine, I was just wondering what a prostate does, and what it looks like.”
“Well, when you’re trying to have kids, the prostate furnishes part of the fluid that keeps the sperm alive along enough to fertilize the egg,” Moe said. “Wait just a minute and I’ll grab an actual prostate from my partner’s desk to show you.”
Moe quickly walked to Rusty’s office and retrieved the specimen jar containing a formalin preserved prostate. According to Rusty, during freshman gross anatomy he had absconded with his cadaver’s prostate. Now he used it mainly as a teaching tool, to show patients what a prostate and prostate cancer looked like. Whether it was cancer or not, Moe had no way of knowing, but the pickled prostate did have a whitish nodule off the right lateral wall.
Howard examined the jar closely. Connie only managed a quick peek.
“What’s these squid-looking appendages coming off the back?” Howard asked.
“Seminal vesicals and portions of the ejaculatory ducts,” Moe answered.
“Well,” Howard said, handing the prostate back to Moe. “If mine looks this ugly, I’d be better off without it.”
“Let’s get things scheduled,” Moe said, setting Rusty’s specimen on the desk.
Moe escorted Howard and Connie back to the front desk, where he instructed Sally to schedule the surgery and the autologous blood donations. He then said goodbye to Howard and personally assured Connie everything would be all right, that it was a pretty routine surgery. As he turned to go, out of the corner of his eye Moe saw Connie put her arms around her father’s shoulders as they sat down waiting for Sally to do the paper work. Moe sighed, then grudgingly returned to the back office to face the ice woman, Diane, and of course, there was another patient waiting.
A few minutes later Moe picked up the hall phone and punched the intercom button to talk to Sally. “Hey Sally, the patient in room one, Edwin Kite, had and IVP done yesterday by the ER for flank pain. I need to look at it.”
“You want the films or the report.”
“Come on Sally, you know I don’t trust those reports.”
“I’ll call x-ray, but it’ll be ten or fifteen minutes before I can go get them. I’m still working on scheduling Mr. Swensen’s surgery. You got any more patients to see?”
“No, Mr. Kite is the last. Why?”
“Well, why don’t you just sneak over to radiology and look at them yourself. It’s all of fifty yards,” Sally said sarcastically.
“Oh, all right, but could you call,