by Hal Ackerman
There’s no ideal time to be told you have cancer. No day when you hope your To Do list contains the entry: Sit across from urologist with results from prostate biopsy, have him lean across his desk and say, “Well, Mister (insert your own name here), you have quite a bit of cancer there! Cancer in nine of your twelve cores. Your Gleason score is seven. Five being the least aggressive form of cancer. Eight being the most serious form of cancer.”
Luckily for me, I know that any moment his nurse is going to burst through the door, all embarrassed and breathless, waving the fax she just got from the lab that read: Dear Recent Biopsian. Boy are our faces red! We mixed up your results with some other poor bastard, and it is not you but HE who has to face his own mortality. We sincerely hope this error has caused you no inconvenience and that you will continue to think of us for all of your future cancer screening needs.
Surprisingly, this does not happen. All the while I’ve been tuned out, this man with large cadaverous eyes wearing a tie and striped dress shirt under his lab coat, has been droning about my choices of treatment. When I tune back in, he seems to be talking about a bone scan he wants me to take, which I explain to him I am far too over-scheduled to even think about for the foreseeable future. I have to pick up my teenage daughter from school, make her dinner, not to mention that I’m in the last hundred pages of a novel I’m writing and I can’t lose the momentum.
His voice becomes insistent enough to penetrate my ring of denial. “You may not have a foreseeable future,” he says. “With your numbers, there is an even chance the cancer may have already metastasized!” He instructs me to take the elevator to the bottom floor of the medical center and follow the orange signs to NUCLEAR MEDICINE. And to do it now.
One night I’m at a candlelit table on a third date with a gorgeous woman, a flawless Catherine Deneuve type who had just gotten out of a twenty-year marriage and inexplicably finds me attractive. The next day I’m in the sub-sub-basement of the university’s medical center, which feels like a bomb shelter with its thick orange walls. And I realize the grim truth that these walls are not meant to keep radiation from getting IN, but to keep it from getting out.
I am met by a lab technician whose name should be Igor. He has a bony bald head, thick glasses and bulging eyes that blaze like a man hatching grandiose schemes. In an open hospital gown, I am placed up against a cold flat slab of glass. Igor scuttles behind a wall of sandbags and flips a switch sending thousands of Roentgens coursing through my body. He informs me that the migration patterns of prostate cancer are as predictable as Ospreys. They seek out the femur, the rib cage. Their vacation isles of the Pacific, he calls them, in his slightly crazed voice. He removes the X-Ray plate and observes, “ I’m seeing a lot of hotspots.” I make the mistake of looking. “Is that me?” I gasp. “I look like Van Goghs’s Starry Starry Night.”
It’s 4:30 of a late November afternoon when I return to the outside world. Everything looks alien, like I have been to another galaxy and returned a hundred years later. The sky is cobalt blue with streaks of orange, and I have cancer. People walk across the promenade, chatting about weekend plans and real estate prices, and I have cancer. Their kids run before them, erratic and thoughtless. Do they shield their kids from me? Am I marked? Can they tell?
There’s a current of fresh-smelling air as day turns to night. I remember walking down Ocean Parkway in Brooklyn on fall evenings like this when I was a child, carrying home a loaf of rye bread still warm from the bakery. Very few children were out at that time of evening. The streets were filled with men coming home from work. Men carrying brief cases filled with adult concerns. I want to be a child out among them now. Comfortably invisible, my hands tucked into my pockets, a loaf of warm bread nestled under my jacket, cool fresh air with the smell of burning leaves in my nose, knowing that when I get home there will be a hot bowl of soup waiting for me.
I always thought it would be my heart.
My father’s went out on him at forty-eight. My uncles’ and grandfather’s too. I do all the prudent things to counter my genetics. No red meat or tobacco, an approximation of tennis a few times a week…all the little paper umbrellas we hold up against the ten-ton safe that’s been falling at us from an indeterminate distance from the moment we’re were born. I get my physical every year around my birthday, so I’ll remember to do it. The doctor knows what I want to hear, and gives me the good news right away, that my heart is fine. He likes that my weight has stayed the same, and so has my height. Same lame joke every year. But I give him the laugh. Because if he’s joking, it means I’m ok. The warrantee is still in effect! I’m good for another year!
I have literally one foot out the door when he Colombos me. Remember Columbo? The rumpled Peter Falk detective? Just when the killer thinks he’s outsmarted him, Colombo asks one tiny question that crumbles his entire alibi? The question that sinks me is, “When was the last time we checked your prostate?” He looks at the chart and says, “Let’s do a digital.”
Lest there be any confusion around the term digital exam. This is not an examination of the digits, rather it is an examination by the digits, into a place beyond the digit’s easy reach.
“Hmmm,” he says, as his fingers probe my upper recesses. “I feel a roughness on one side. Was this ever here before?”
The room begins to spin. “How the hell do I know if it’s been there? That’s your damn job to know.” But he knows and I know. It wasn’t there before.
At this stage of my life, I am so colossally ignorant of my own body, I have never heard the term: Prostate Specific Antigen. To me, PSA means Poetry Society of America. Or Public Service Announcement. At home I do nothing to spackle in the gaps in my knowledge. I follow my Hungarian grandfather’s advice about avoiding doctors. “Vhat, doctors. They’ll look, they’ll find.”
My PSA comes back as 11.8. I try to hear or inject some relief in his voice, like, Gee, that had us worried there for a minute, but whew, it’s only 11.8.’
“What’s normal?,” I ask. I brace myself to hear nine, maybe eight. That I’m a little bit high but that if I cut out coffee for a couple of weeks…
He says that at my age two is a safe limit. Anything over four we’d be alarmed.
“Do I have cancer?” The words clatter out of my mouth like mah jong tiles. I have never before spoken a sentence where the words “I” and “cancer” were in such close proximity.
The four other guys in Dr. Fitch’s waiting room are way older than I am. At least they look older. At least I hope they look older. All of them are there with their wives. One of them smooths her husband’s collar. Another one points out a picture in a magazine they both seem to recognize. I feel a little bit heroic being here on my own. I don’t need a damn buffer. I AM the buffer. My name is called and I am conducted into the exam room. The shelves are lined with the tools of the urology trade: rubber gloves, finger condoms, KY jelly. I wonder why would someone even become an urologist? Is he too shy to be a gynecologist?
A starchy nurse with a clipboard asks me a battery of questions. Weight loss? Weight gain? Lack of sleep? Sleep all the time? Constipation? Diarrhea? Dribbling after urination? Inability to get an erection? I tell her this sounds like some first dates I’ve had. She assures me that what is about to happen will not be like a first date.
Doctor Fitch comes in with a needle the size of an elephant gun and tells me to drop my pants. For readers who have not had the personal experience of a prostate biopsy, picture a bratwurst on a barbecue grill. This is your prostate. Then imagine a sharp-pronged fork, or a spring-loaded skewer jabbing through the skin to see if its juices spatter. Think of that happening twelve times. And now think of where that bratwurst is.
People don’t know much about the prostate. The penis is often thought to be the seat of manhood. Especially by the penis, since it has only one eye and thus no perspective. When my daughter was five she asked me if all men had penises. It was a beautiful spring day and we were up in the vegetable garden staking tomatoes. But when your daughter asks you about penises, you put aside anything else you thought was important and give her the best answer you can. You don’t want her to spend too much time doing extensive hands-on research. So I said yes, that the males of all species had penises, that having a penis is what makes a man a man.
She thought about that for a moment, and said, “Does Mister Rogers have a penis?”
Our deal was that she could always rely on me to tell her the truth, even on the hard questions about God or the Easter Bunny. So I said, “Well, I’ve only seen him on TV and he was wearing all his clothes, but yes, I’m going to say Mister Rogers has a penis.”
She considered this thoughtfully too, and then rendered her opinion. “I think Mister Rogers is too nice to have a penis.”
Think what this girl understood about men at the age of five. It’s our comedy and our tragedy. Gay or straight we live in male metaphor. We puncture the atmosphere with rockets. We probe the bottom of the sea. We’re permeators. perforators, penetrators. Okay, we’re pricks.
Personally, I prefer to avoid all forms of mortality. My philosophy evolved from playing pinball, and its defining ethos: score as many points as possible while the ball is still on the table. The problem now is deciding which of the two treatments to take—surgery or radiation. I have downloaded a boatload of material off the internet that I can’t bring myself to read. They both sound horrendous. I have not told Annie, my daughter. A father’s role is to be his child’s external kidney, to filter troubles OUT of her life, not to be the cause of them. I haven’t told my mother either. She’d blame herself and I can’t bear the weight of her concern. I avoid thinking about it, hoping it will go away, but every day I put it off, I feel the thing biting off chunks of me for dinner. Like my tumor is Popeye and my organs are spinach. I need someone to tell me what to do. This is a job for my friend, Big Paulie.
Big Paulie is right out of The Sopranos. Big mug of a face. Voice like a triple-decker brisket sandwich. But a total sweetheart. If he had to break your legs, afterwards he’d drive you to the hospital and water your plants.
I hand over the pile of information to him and prostrate myself at the temple of his wisdom. He speed-reads the pages and looks at them like somebody had pissed in his spaghetti. “Dja read any of this? Are they kidding me? Door #1 You got your radical prostatectomy. Meaning they cut it out and throw it away. Sounds good except that they have to cut YOU open to get at it. Side effects are “Incontinence and erectile dysfunction.” Meaning you’re a eunuch in diapers. Forget it. What’s Door Number 2? Radiation? Oh, very nice. They microwave your ass. Side effects–? Here we go again. Limp dick and diapers. Add to that exhaustion and puking. And after all that, if any of the cells have escaped you gotta do chemo anyway. So forget that too. What else ya got?”
“That’s pretty much it.” I tell him.
“No, that can’t be. This is like when we used to take the freshman up on the roof and give them the philosophical question they had to answer correctly get thrown off. You remember the question? If you’re buried up to your neck in a vat of wet horse dung and somebody throws a pail of vomit at your head…Do you duck?”
Thankfully I discover a Door #3. It’s called hormone blockade, or Intermittent Hormone Deprivation Therapy. It’s a little bit on the edge, but the older brother of a friend of mine went through it and recommends it highly. He sets up an appointment for me with Dr. Terrence Carter. He’s tall and lanky and young, with the manner of a well-brought-up country boy. Before he even tells me about the treatment, I know I’m going to take it. Not just because it sounds easy—four pills every night and a shot once a month—but because he looks me in the eye. He sees a person, not just a set of symptoms. He asks if I’m as frightened as I look.
“Tip of the ice berg,” I tell him.
“That’s okay,” he says. “Cancer is frightening.”
And suddenly everything breaks and I’m blubbering like an idiot. I’m supposed to be this parent and teacher and elder, but I’m like a frightened three-year-old. When the spasm ends, I feel better. I’m excited to tell Big Paulie about it.
“Are you outa your mind? A couple of pills every night are supposed to cure cancer? They wouldn’t cure hemorrhoids.”
I explain to him that the medications inhibit your body from producing the hormone that the cancer feeds on. That the treatment does to the cancer what cancer doers to the body. It puts it in a state of siege. Starves it. Shrinks it down.
Naturally he wants to know the downsides. Which naturally I downplay. The regimen doesn’t completely kill the cancer. After nine months I have to go to Seattle, where they’ll inject a bunch of radioactive seeds into what’s left of the tumor; but I’m in and out the same day.
He’s still skeptical. “Anything else?”
He knows me too well.
It turns out that the hormone the cancer feeds on, the one the treatment stops your body from making, is testosterone. So I’ll be testosterone-free for a year. No sex drive. No libido. My body chemistry will be like a woman in menopause. I can’t get him to stop laughing.
“You’re gonna be a chick!”
“The term they use is chemical eunuch.”
Another guffaw. And this time I can’t help but laugh with him. “It’ll be good for me,” I resolve. “I’ll be like Dustin Hoffman in Tootsie. He came out a better man. Plus, one guy out of ten keeps his sex drive, I’m sure I’ll be that guy.”
He sees how desperate I am to have him believe me. “Yeah,” he says, “you’re doing the right thing. Just answer me one question. If you grow tits, can I dance with you?”
Notwithstanding Paulie’s offer, I fill my prescriptions. Thirty blue Proscar. Ninety white Casodex. They sound like Greek heroes. Noble Proscar. Courageous Casodex. But they look kind of small to fight cancer. Two weeks later I haven’t opened the bottles. I assure concerned friends who ask, that I want to wait till the beginning of a month. It’s symmetrical. Or, I have to finish the book I’m writing first. Nobody believes that one. A writer writing to avoid doing something else? Finally I take them damn pills! I swallow one. Then the other. I yell at them with venom, “Okay! Are you happy?? You’ve made me a cancer patient!”
I hate regulation of any kind. I hate routines. But if I’m going to be a cancer patient, I’m going to be the best patient in the history of cancer. I force myself into regimens. Weight-bearing exercises to ward off muscle decay. Calcium pills to prevent bone loss. Soy shakes for estrogen. I refuse to buckle.
Illness is measured in milestones of loss. Month by month as the treatment takes effect and my testosterone level drops, weird physical changes occur. One day the hair under my arms is gone. Then it’s gone from my chest and my legs. A glob of fat accumulates around my middle. One night at a Chinese restaurant I take a spoonful of soup and my entire body flushes. I break out in a full sweat. “Did it just get hot here or is it me?” The women at the table take far too much pleasure in this: my first menopausal hot flash.
Desire diminishes. Out jogging one day, I pass a workout center just as group of women in leotards comes out, their young birchy bodies crackling with pheromones. Perspiration glinting off their skin. The way their hands move, their arms, glimpses of exposed flesh. In the past, I would have been drawn to them like a trout hooked through the nose. But now they could be nuns at prayer.
Even worse than the physical changes are the emotional changes. I’m becoming soft and sallow. Sickeningly sereeeene. Nothing bothers me. I WANT things to bother me. I’m a New Yorker. We’re born pissed off. One day I’m driving—and you know how we New York drivers are: what civilized people call “road rage,” we call courtesy. A woman driving an SUV is putting on makeup, talking on her cell phone. Maybe she’s got a vibrator going. I don’t know. She cuts me off. I give her the horn. Not the big blast, just a polite ‘bip.’ And she gives me the finger. The old me would have rammed her into oncoming traffic. Instead, I smile and tell her to have a nice day. What kind of man am I becoming? I want to be Jack Nicholson! I’m becoming Mister Rogers. A man too nice to have a penis!
Patty, my Catherine Deneuve beauty, and I are having problems. The sexual magnetism that brought us together is lessening. I come into the bedroom late one night. Patty is asleep on top of the covers. Wearing a black slip, bathed in moonlight. Beautiful and accessible. But as I come close to her, the prospect of sex makes me slightly nauseated. And I realize to my horror that it’s happened. My libido is gone. I will not be that one guy in ten. I am a neuter.
When I was in junior high I used to ask these weird questions. Like, can you gain weight from apple pie you eat in your dreams? Or if you run for one second in each of the four directions have you run for one square second? But the thing I really wondered about was where light goes when you turn off the switch. I want to know where mine has gone and if it will ever come back.
After eight months on the medication, my PSA is down from 11.8 to 0.05. I am ecstatically optimistic. With the finish line in sight, I have a setback. It is decided that my high initial numbers “support the possibility” that some cancer cells might have escaped the prostate capsule and begun to migrate. The decision is made to err on the side of caution, and I am to have thirty doses of “conformal beam” radiation. The idea is to create a kill zone, a ring of fire that will vaporize any cells attempting to escape.
A solid plastic sheet is placed in a vat of hot water and made pliable, then molded to the contour of my body. Some holes are cut on each side that match a series of bolts on the table so I’ll be in the exact position every time. Six weeks. Five days. Ten blasts per day. With each session, my internal temperature builds up. After two weeks, my plumbing becomes inflamed. After three, my organs start to boil.
At night, I wake every hour with the ferocious need to pee. I walk like a zombie to the bathroom. Wait for the deluge. Get a dribble. I’m like a new bottle of ketchup on a cold winter day. Back to sort of sleep. Up in another hour. Wait, dribble. Stagger back. I make the mistake of looking at myself in a mirror. My skin is the color of a used bandage.
Driving is the worst. One day it’s so bad I have to pull over on the freeway, or pee in my pants. I don’t even see the cop car. He leaps out of his black and white. “Hey You. PUT THAT THING AWAY.”
I feel my neck bowing in submission. “I have prostate cancer,” I mumble. I take a card from my wallet. He doesn’t want to touch anything that touched my hand.
It brings me back to a day in 1962. My father was a CPA. One of his clients got us tickets for a New York Giants football game. We got a little lost finding the stadium, and all the parking lots were filled. My father had already suffered two heart attacks, and he couldn’t walk far. He pulled up to a lot with a chain across. The attendant was maybe nineteen, lean hair slicked back. “Sorry bub. All filled.”
My father rolled down his window. I thought he was going to slip the guy a twenty. Instead, very quietly, so I wouldn’t hear, he said, “I have a weak heart.” After we parked, I walked deliberately faster than he could and then made a big ceremony of slowing down for him. I was so afraid of his weakness tainting me.
When the game was over, it had gotten cold and raw. I took the keys from him, told him to wait while I went for the car. It was my first time driving it. My back found a space in the indentation worn by his back. His eyes fluttered and he fell asleep crossing the Throgs Neck Bridge. Like I used to fall asleep in the back seat to the murmur of adults talking. I kept the car at a steady speed to let him sleep all the way home. He died a month later. Only now do I realize the terror he must have felt every day, knowing that the ten-ton safe was getting closer to crushing him.
At last the day that had seemed so far in the distance has arrived, and I am flying to Seattle where the radioactive seeds will be implanted. The carpet of the Princess Hotel smells from cabbage cooked in the 1940’s. The guy checking in before me has a walker, an oxygen tank, and a colostomy bag. He and his wife are half deaf and have to repeat everything five times, and they still miss half of what the other one said. Maybe that’s the secret to sustaining relationships. Less communication.
I don’t know why I didn’t let Patty come with me. I know why I said she couldn’t come. “Oh, Patty. We’d have to get a nicer hotel. You’d pack too much. I know you want to be there for me, but you can ‘be there for me’ here.” A cold wall came down across her eyes. I guess we both knew we were done.
There is an hour of daylight left after I check in. I wander the city. I find myself at a supermarket, and when I come to the checkout I see that I have put a set of dishes into my cart plus a plant and a painting of George Washington on his horse. What was I thinking? That I was going to decorate my room at the Princess hotel? I put it all back and go outside with a 59-cent Bic pen and a spiral notepad and begin to write everything I’ve bottled up. An ambulance passes, siren howling, heading toward my hotel. The first line I write is: “The angel of death came looking for me today, but I was out.”
I’m up before the alarm the following day and walk to the hospital. The admissions nurse is very cheery. “Hello,” she sings. “Have we had our two Fleet enemas? Have they had their desired effect? Doctor can’t have any cloud cover when he makes his bombing raid.”
Just as suddenly it’s all business. I am brought into a prep room, given a hospital gown, told to undress, strapped down onto a table, given an epidural, numbed from the waist down. The anesthesia takes effect. I am rolled into the operating theatre.
From twilight sleep, I hear murmurings as the doctors go to work. A long thin needle is inserted into my rectum. One by one, the radioactive palladium seeds are strategically injected. I think I hear one of the doctors say the tumor has shrunk nicely and they’ll only need seventy seeds instead of ninety. I think I ask if I get a discount. I think they say yes.
I encircle myself with images of friends. Patty is outside the circle, trying to look in. I have a stunning revelation of what an absolute jerk of a boyfriend, what a jerk of a person I am. I want to leap off the table and tell her I’m so sorry. That of course I should have let her come. Of course that would have been a mistake, as I have a catheter inside me.
An hour later, it’s over. The first time I pee it feels like I’m giving birth to a porcupine through hot barbed wire. But by evening I’m okay, and I take the night flight home. The moon hangs outside the plexiglass window like a glowing earlobe. They’ve given me some post-op instructions. Children may not sit on your lap for six months. Sexual intercourse may be resumed. However, initial ejaculations may be discolored brown or black or red. The word the pamphlet uses to describe this condition is normal.
I must have dozed in the taxi, because I find myself at home. Lights are on. I open the front door, and I am surrounded by a warm rich aroma that permeates the house. Patty is there. She has made me hot soup. Then I see that she has also packed the few things she keeps here. Her contact lens solution, a French sweater, a pair of glasses, her hair dryer.
“I’m glad you’re well,” she says. She holds my hand for a moment, then stops before she leaves. “You think you’re easy to be with but you’re not. You say you want to be heard and felt, but I think you need to be adored and cherished in order to feel loved. And when you’re not, you become mean spirited and withholding. You inflict pain with your humor. Cancer is no excuse.” There is a long silence. I just thought you should know that,” she says.
“I kind of wish I had.” I say.
With the treatment over, the manic of doing is replaced by the wallow of waiting. The thousand pound gorilla lurking over everything is the critical PSA test six months down the road. Any results over 1.0 means that the seeds haven’t worked, and I have to have something more radical.
To kill time, I make a foray into online dating. I run an ad with the headline: OLD. RICH. DYING: Terminally ill man looking for a woman whose personality is so obnoxious she will make death a pleasant alternative. This is LA. 178 women respond.
Six months finally pass. Blood is taken. The results comes back 0.005! The seeds have worked! I am elated to share the great news with Annie. But something happens and we get into a ridiculous fight about something stupid that ends with her screaming, “I wish you were dead,” and storming out of the room.
I am left on the verge of tears. Is this why I fought so hard to save my life? Strangely, the answer to myself is, YES. And I think maybe this is the moment that prostate cancer makes a man of me. For I realize I’d rather be alive hearing her wishing me dead, than dead and her wishing me alive. A moment later she flounces back into the room, throws herself on my lap, and says she didn’t mean it. I multiply the gesture by its weight on Jupiter.
A mother has a child’s love whatever she does. A father has to earn every moment of his by explaining and making safe for his child a world that still frightens him and that he’s never understood. In retrospect, it’s weird to think of cancer as a gift, but that’s what it took for me to understand some obvious simple basic truths: you choose a woman, not to sleep with, but to be awake with. In a daze of pain killers, my mother once said, “Time goes by so slow and so fast.” It’s true. We are and then we aren’t. Our light is, and then it isn’t. I hope I won’t forget everything I’ve learned when my testosterone fully returns: that we aren’t mere slaves to our chemistry. We’ll see.
Hal Ackerman has had numerous short stories published in literary journals, most recently in The Idaho Review. Others include The North Dakota Review, New Millennium Writings, Southeast Review, The Pinch, The Yalobusha Review. “Roof Garden” won the Warren Adler award for fiction. “Alfalfa,” was included in the anthology, I Wanna Be Sedated…30 Writers on Parenting Teenagers. “Belle & Melinda” was selected by Robert Olen Butler as the World’s Best Short Short story for Southeast Review. THE DANCER HORSE received a Pushcart Nomination.