Hunting for Hippocrates. Warren J. Stucki
have to change his first impression of the man. “Well, let me take a little time and tell you about the PSA, what it means, and where we go from here.”
Moe had recited this PSA narrative so many times he could literally mouth it, while in part thinking about other, more personal things. “The PSA is a relatively new blood test. I guess it’s been around for about ten years now, but has only been in widespread use for the last seven or eight years. PSA is short for prostatic specific antigen. Although it’s a blood test designed to pick up on cancer of the prostate, it’s not always accurate. In fact, the more experience we get with it, the more inaccurate we realize it is. However, it’s accurate enough of the time that it makes it worth doing. In other words, it’s not a totally worthless test.” Moe droned on, but had fleeting thoughts of Cozumel. Three weeks from now, he was leaving for Cozumel. And no pretense of going to a meeting. This was all vacation. It was about time that Rusty had a turn watching the store.
“A PSA of 8.7 is not sky high by anyone’s standards, but is high enough to warrant further testing. By further testing, what I mean is to perform an ultrasound of the prostate.” Judy would be going to Cozumel with him. They would do some diving and get caught up on some rare and much needed personal time. There had been a real dearth of that lately.
“Ultrasound has certain advantages over just the finger exam of the prostate. With the ultrasound, you can see the whole prostate, including the interior of the prostate, whereas with the finger exam you’re just feeling one surface, that being the surface next to the rectum. If there is anything suspicious, you can also biopsy using the ultrasound and place the needle, with pinpoint accuracy, right where you want. In fact, what’s recommended now days, even if you don’t see a suspicious area, is that you biopsy each section of the prostate. From your point of view, an ultrasound feels just like having a finger exam of the prostate. The whole procedure takes about five minutes. Obviously, it’s up to you, but I think we should go ahead with the ultrasound, Mr. Swensen.”
“You mean, you biopsy through the rectum?” Mr. Swensen grimaced slightly.
“Yes, that’s why Sally gave you some antibiotics to take when you made the appointment.”
“Whatever you say, Doc, but I can tell you right now, I won’t like it.”
“Well if you do, we could set aside some time and do it once a week,” Moe laughed, then stood to leave. He was beginning to like Mr. Swensen.
As he left the exam room, Moe was met by Diane who directed patient flow like a traffic cop. She suggested that he see the bed wetter in room two while she was getting the procedure room ready for Mr. Swensen’s ultrasound. Diane also reminded him of the Merck lady in his office, and at this point in time he was running approximately an hour late.
Moe made quick work of the bed wetter. Treating non-disease always irritated him. Then he trudged back his private office and his obligatory visit with the Merck drug detail lady. It was an unwritten law, no visit, no free samples.
Connie Swensen stood as Moe entered the room. She was a pretty, shapely woman of thirty-something, with flawless make-up, meticulously dressed and natural blonde hair. Today, she was wearing a light gray skirt and a loose, low-cut, gossamer white blouse. In spite of her captivating, albeit slightly cosmetic appearance, she had intelligent, blue eyes with just a hint of sadness laced in the lines of her face. This trace of sorrow tended to offset her Barbie Doll appearance and gave her the more tangible image of a real person. Faintly, Moe caught the bouquet of designer perfume.
Moe shook Connie’s hand as she offered him a Merck pen. During the exchange, the pen inadvertently clattered to the floor. Bending at the waist to retrieve the pen, she exposed the tops of her ample, bulging breasts straining against a delicate, white lace bra. Moe couldn’t help but notice. And though he realized this was part of her sales pitch, it always seemed to work. He consistently gave her more time than her male colleagues, and subconsciously, Moe knew he would favor her company’s products.
“How are you today, Dr. Mathis?” Connie said brightly, settling back into her chair.
“Fine,” Moe said with a sigh, depositing his tired body into the stuffed vinyl chair behind the desk.
“You’re seeing my father today. Obviously, I wouldn’t let him see any other urologist but you,” Connie bubbled. “So today, I guess, I’m wearing two hats, the caring daughter accompanying her father into the eerie Steven King world of the doctors’ office, and my usual role as a Merck representative.”
Moe looked puzzled. It took a minute for him to make the connection. “Oh, Swensen—Mr. Swensen is your father! If—if I would have known that, I wouldn’t have been quite so nice to him. You don’t look anything like him,” Moe laughed, stumbling through his embarrassment, then blushing as he recalled the view of her bending to retrieve the pen.
“I take more after my mother’s side, at least as far as physical appearance, but in personality, I’m more like my father,” Connie said warmly. “How’s Pop doing?”
“Well, he has a mildly elevated PSA, probably nothing, but to make sure, we’re going to ultrasound his prostate. It will only take a few minutes.”
Connie’s smile was dazzling. “Dr. Holman wanted to send him to Dr. Rasmussen, but I insisted on you.”
“I wondered about that,” Moe said.
“You’re my only doctor to see today, so take your time. Anyway, I know he is in good hands. The best.”
“Thank you,” Moe said weakly, annoyed that he felt tongue-tied around Connie, just as he did years ago in high school when he tired to talk to pretty girls.
“Sally tells me you have a trip planned for Cozumel. When are you leaving?” Connie said, abruptly changing the subject.
“In about three weeks—” Moe said, as his mind started to wander. He was mesmerized by Connie, and involuntarily he glanced to see how high her skirt had hiked up on her crossed, slender thighs which were tantalizingly packaged in sheer nylons. As expected, it was a pleasant sight. Moe had to forcibly remind himself that he just didn’t have time for small talk today.
“I’ve always wanted to go to Cozumel, but I’ve never been able to find anyone to go with. And I certainly don’t want to go by myself.” Connie gave Moe a ‘know-what-I-mean’ look. “Did you know I’m a certified diver?”
Moe wondered if this was a come-on. Someday, he really ought to ask Connie out. However, instead of pursuing that inclination, he said. “No, I didn’t. Maybe someday we’ll have to go diving. What do you have for me today?”
“I’m sorry, Dr. Mathis, I know you have a waiting room full of patients. I’ll be brief. Those recent studies down-playing the effectiveness of Proscar are somewhat skewed,” Connie stated. “There is a sub-population of patients for which Proscar works very well, those being the patients with the kind of prostatic enlargement that contains a lot of glandular tissue and not so much stroma. A majority of these patients had a substantial reduction in their prostate size and obstructive symptoms with a trial of Proscar. I hope you will continue to use Proscar, particularly on this sub-group of patients.”
Moe, though he had his doubts about the drug, assured her he would continue to use Proscar, and that he would also keep her updated on the results of her father’s tests. After looking at his watch, he stood and excused himself.
“Are you okay, Dr. Mathis? You look tired.”
Again Moe wondered if the girls had collaborated on their comments about his looks, or
if he really did look that bad. Right now, however, he did not want to get into another lengthy conversation about his father dying.
“Nah, I’m fine. Just my week on call,” Moe said lamely, then headed toward the third exam room with Mr. Robinson, and another lengthy monologue on the PSA blood test. Someday, he would be more efficient and video tape his discussion.
After Moe finished talking with Mr. Robinson, Diane was ready for the ultrasound on