This is one of several essays from my private cancer journal. It is not intended as anything than a record of my states of mind as I struggled with the disease and the effects of the treatment.
The Diagnosis: Why Not Me?
January 31, 2000
Whenever I read how someone reacted to the news that they had cancer, the reactions are so similar. There is usually shock, grief and the bottoms of their lives dropping out.
It always makes me wonder why I didn't react that way.
I had been suffering from hip, leg and lower back pain so crippling that I had trouble walking, sitting and even trying to sleep at night. Stupidly, I thought I had merely inherited my mother's bad hips that had forced her to have three replacement operations. So I finally gave in and got a checkup, telling the doctor all of my symptoms. She ordered a battery of blood tests and x-rays, which I had done. In the lab, the technician looked at the string of nine labels he had printed out for the various vials and said, "Boy, they really want to know about you!" A small flag went off somewhere. I was told I'd get the results in a few days.
An hour or so later I returned home and was standing on the front porch thinking about the technician's remark when it came to me quietly and calmly. I don't have osteoarthritis. I have cancer. I'm dying from cancer.
There was no panic, no grief and not even a denial that I could be wrong. My stomach didn't even drop. I simply stood there and realized it as calmly as I might realize that I need to change the oil in the car.
A few days later, on November 23, 1999, the urologist called me.
"I'm very concerned about your PSA," she said. I had no idea what PSA was but I said nothing. "It's one of the highest I've seen. I think you have an advanced and aggressive prostate cancer."
Even with her saying it, nothing happened to me.
"I thought so," I said matter-of-factly, referring more to the cancer diagnosis than the prostate part.
There was silence from her side. I didn't think much of it at the time. Maybe she was surprised and relieved that I wasn't devastated or wanted to challenge her findings.
"You did?" she finally asked. Now I could hear the puzzlement in her voice.
"Yeah," I said calmly. "Now what?"
There was another pause, as if she was trying to deal with my reaction.
"We need more tests," she said. "I'd like to schedule you for a bone scan and a biopsy."
She did and I wrote down the dates and then hung up the phone and thought, how strange. It has just been confirmed that I have prostate cancer and I'm as calm as I can be. It must have been that trip to the ER two months earlier.
It was my second trip to an ER. The end of May, I had suffered a heart attack while in Columbus. I awoke at about 3 a.m. with pains in my chest and arms and for whatever reason thought, "I'm having a heart attack." I went to the phone and called 911 and gave them my address. Then I called my friend Brian to tell him. Then I wisely unbolted and unlocked the front door to my second floor apartment and laid down on the couch and went unconscious.
The next thing I remember was being on the gurney as it was tilted awkwardly down the stairs and then nothing until I woke in a hospital bed with tubes and wires running from me. I had had a heart attack, someone told me, and was given an angioplasty. They explained the process, telling me how a small piece of plastic was left in the clogged artery to keep it open and I should be okay.
I tried to imagine a TV camera pushed up through a vein in my groin into my heart and was glad I was unconscious. I had a bruise that reached from above my pubic hair to nearly my right knee. Walking felt like I was carrying 500 pounds at 10 miles elevation. After four days, I was going stir-crazy and they agreed I could be discharged. Brian's wife Linda took me back to the apartment.
The import of a heart attack never hit me. I was more irritated at the physical side effects. Between the leg-hip pains and the exhaustion in walking, I was spending most of my time stretched out on the couch trying to catch my breath or to find a comfortable position.
I was well enough by August to drive to California to see my son. Then I headed back to Ohio, thinking I'd get a different job and start a new life. Most of the trip was in agony. Some days I could drive only a couple hundred miles before giving in to the pain and finding a motel for me and Mac and Jack., my two traveling fur-companions. I finally limped into Cincinnati to see Caren, a friend I met while I lived in Columbus, two hours to the north. Maybe Cincinnati would be more interesting, I told her.
About ten days later, I hit the ER again.
Caren and I had just entered a restaurant and were waiting to be seated for dinner when I became dizzy and short of breath. I excused myself to get some air but it didn't help. I was growing weaker and dizzier so I went to her van to sit down. She came out to ask how I was.
"Not good," I said as I tried to catch my breath. It felt as if someone was sitting on my chest. "I think I'm having another heart attack. Call 911."
As she left, I closed my eyes and realized I was losing consciousness. I struggled to open them but they hardly moved. I could barely breathe. I was sliding into unconsciousness and the thought came to me, "So this is what it is like to die. It's not so bad this way."
Caren came back to tell me she had called them. She gripped my hand. I tried to return the gesture but couldn't. I was too weak but I could feel her there. She was my contact with consciousness.
Within minutes her hand slid away and voices were on my left asking me questions. I couldn't answer. I couldn't move. A clear plastic mask was put over my nose and mouth. Someone was telling me to breathe. The air was cool and I worked to pull it into my lungs. More voices off to the side. I turned my head and could open my eyes enough to see Caren standing about 15 feet away, her face a mask of tears and worry.
"I'm better," I tried to say to someone next to me. He said something in reply as I was lifted from the van and placed on a gurney. I was breathing better. Caren came over and touched me.
"I'm okay," I said, trying to reassure her. "I'm better now."
They wheeled me to the back of the ambulance and I could hear Caren talking with someone who told her she would have to ride up front. They slid me in. I was feeling better with each breath and told the attendant. He told me that was great as he slapped electrodes to my chest and wrapped my arm for blood pressure. The van pulled away with siren screaming. I watched out the back window as the highway receded. The attendant was on a radio giving my vital statistics. My blood pressure was something like 75 over 50 and pulse was 40.
"I guess I'm too low," I quipped, trying to show him I was feeling better.
"You'll be fine," he quipped back. Must be what he tells everyone, I thought.
By the time I was in the ER, whatever had hit me at the restaurant was completely gone. I told Caren, who was at my side, and the doctors. Everyone nodded but no one wanted me to get up and leave. So Caren hung out with me for a couple of hours in ER before I was moved to a room. Then she finally retired, taking a taxi back to the restaurant to get her van.
The next day they told me that they didn't know what it was but it wasn't a heart attack and they wanted to keep me there for some tests to see if they could figure it out. On Caren's urging, I agreed.
Lying there in the hospital, I realized that the near-death experience that escaped me back in May really came home this time. When I felt I was losing consciousness in the van, I believed I was actually in the process of dying and it was okay. I wasn't afraid. I was calm and relaxed, thinking, "So this is what it is like to die."
That feeling had happened once in a dream perhaps 20 years ago. In the dream, I was in a bed with my eyes closed and either very old or sick. I heard someone say, "My Lord, my Lord" as if addressing me and then I slipped away. It was such a wonderful feeling, like divesting oneself of old, dirty, heavy clothes. I had died in the dream and then I awoke. I always remembered that dream.
So when I was standing on the front porch and it came to me that I didn't have osteoarthritis, that I was dying of cancer, I was calm. I've already done this, was what I realized. I've already been through facing death and I'm not afraid of it.
I put out the cigarette and went inside to watch TV and here is where the synchronicity gets wild. I turned the TV onto HBO [a cable movie channel] and found "Six Months To Live," a special featuring several people dying of cancer, including a young kid. I watched it. When it was over, I went back outside on the porch to have a cigarette and think. Those were brave people on the show, I thought. I hope I can have that courage. Then I went back in and pulled out my laptop and started my cancer journal. The first entry reads:
Then I go into how I had already faced death with the second ER visit, the stuff I've just mentioned.
I still feel strange when I read (mainly on the prostate cancer mailing list) about the shock that hits people when they are told, as if there is something wrong with me. It seems to be part of every cancer story. It just wasn't part of mine.
Nor was there shock when I got the bone scan and saw the photos and the black that was concentrated in the pelvis, spine, ribs and shoulders, telling me it had metastasized and was now confirmed as terminal.
My shocks came later.
I learned that death by the form/type of cancer I had can be one of the most painful.
I learned how toxins would destroy my liver and kidneys.
I learned that my bones would get brittle and could easily break and then refuse to heal.
I learned that I could suffer from "spinal collapse" where a vertebrae shatters, rendering me immobile from that point down.
I learned - and experienced - the side effects of the hormonal therapy they put me on, where the libido is killed and it ripped into my sense of masculinity and identity.
I heard the words "end stage" for my cancer. I knew I was dying but the words hit me in the stomach the first time I heard the oncologist say them.
Time and again, I broke down and cried. My emotions were ragged and on the surface. A mere movie could send me into depression. I began to consider the possibility of suicide to avoid the end.
Was this the price for taking the diagnosis so calmly?
Or maybe I was just didn't get it and it took awhile for it to sink in.
Regardless, it has made me feel different from the others with PCa. Not superior. To the contrary. It is as if I was spared that agony so I could better appreciate the rest to follow. I don't know.
So many men ask, "Why me?" when told they have cancer.
I now ask, "Why me?" when I look at how calmly I responded. Why was I spared the shock?
Why not me?
[Postscript: Little did I know at the time, the shock was about to arrive in a different form.]
November 23, 1999 - I was diagnosed with cancer today. Fortunately, it didn't come as a shock. I don't know how I would have reacted if it came as a surprise.