Each Time, A Little More Composure

The release of my book Midpoint this week resulted in some old friends reaching out to ask how I’m feeling eighteen months after undergoing surgery for stage-3 prostate cancer. The book ends with my checking results from my first postoperative PSA test in March, 2018. For people I don’t see often, that would be their most recent update on my health. When I respond to these well-wishers, I hesitate on exactly what to say. My first thought is to write something like “I’m feeling great!” which describes how I feel physically. But many cancer survivors will tell you that cheerful statements like that can feel like tempting the Fates. “All clear for now,” on the other hand, can come across as needlessly tentative or gloomy. After my initial hesitation on how to respond, I usually tempt the Fates anyway—mostly because the Fates don’t exist, or if they do, they’re probably not reading my emails. I have a tendency to get inside my own head on this stuff.

At my one-year PSA test (I’m checked every six months now), I asked my surgeon, Karim Touijer at Memorial Sloan Kettering, what the likelihood of recurrence is based on my post-surgery pathology report. He thought for a moment and said, “Your margins were clear as I recall.”

“Definitely,” I replied.

“And there were no positive lymph nodes,” he added, “and seminal vesicles were clear.”

“Right.”

“A recurrence is extremely unlikely,” he said. “And the farther you get from surgery, the lower the risk becomes.”

I didn’t remind him that my risk level was “high-intermediate.” Why risk biasing what had been a very satisfactory reply?

I was tremendously relieved by his response, as you can imagine—particularly because, as the last two tests approached, I went from feeling healthy and optimistic to annoyingly shaky. By the time I went down to Sloan Kettering in New York City, gave blood, and returned home to await my results on MSK’s portal, I was a pathetic mess. Both times, when I saw the magical <0.05 ng/ml result on my computer screen, I chided myself for getting so wound up. For my eighteen-month test, I’m determined to be at least 20 percent less pathetic.

Recapturing Those Old Rhythms

The reality about going through a bout of cancer is that, as much as your attention gears way down to focus on the immediate threat of the malignancy inside you, the rest of the world keeps functioning as it always has. During treatment and recovery, that gearing down resulted in my feeling dissociated from life’s quotidian concerns. After I recovered and was assured I wouldn’t succumb to cancer any time soon, I had to get back into the rhythms of life. Doing so has had a real benefit: It distracts me from fretting, for example, that the odd twinge in my lower back is from a tumor on my spine. Even though it would be almost impossible for that to happen soon after a clear PSA test, I can convince myself of almost anything when I can’t sleep because I inhaled a piece of Enstrom’s toffee at 11 o’clock. Staying engaged with life’s rhythms—planning my budget, working on my writing, mowing the lawn—is the best antidote to angsting over recurrence. It’s also what you have to do, unless you plan to join a monastery to focus on worrying full-time.

Notably, those same rhythms have also distracted me from being the model patient I described in my book. It’s been weeks since I did a Kegel exercise, those squeezey contractions deep in your junk to tighten the muscles of your “pelvic bed.” And ever since I stopped having calls with the social worker at MSK’s Sexual Health Clinic, I’ve been way too casual about my injection therapy. The target was three times per week; but, according to the log I keep, I’m averaging about half that. Without Diana asking, in her thick Brooklyn accent, “So howwww’s it going?” I’ve become something of a slacker. Partly, I haven’t been as good about the shots because things are working mighty well without them. So I get a little, well, cocky about my progress. I’ve got an appointment at the Clinic in October, though, so, knowing me, I’ll ramp up the injections as the date approaches, like I’m cramming for a math test. For all the good that will do. There’s nothing new about patients becoming less committed to their recovery when they feel, in most respects, like they’ve healed. I often remind myself of that fact, not to justify my slacking, but to remind myself it’s because I feel better.

One, Cool Cucumber—Eventually

That said, my body is definitely different since the surgery. The truth is, I’ve accepted the reality that I’ll never feel the way I used to, and that it’s a relatively small price to pay. After all, everything works pretty well. It’s just that I don’t trust my body as much as I used to. That could be, like so many aspects of this experience, all in my head. Analogous to Dr. Touijer’s observation about my risk of recurrence, the farther I get from my surgery, the more habituated I will become to this modified vehicle. Visually, that’s already happening, with my surgical scars having nearly disappeared. On a recent trip to Conesus Lake to visit my wife’s family, I took off my shirt and realized (maybe with a little disappointment) that no one would look at my torso and say, “Ah, so that’s where they made the cuts, eh?” 

I’d like to think my bothersome anxiety about recurrence will disappear as fully as the scars have, but I’m less sanguine on that prospect. Even so, if the worry only rears up before my PSA tests, I can live with that. As I said, I plan to be incrementally less pathetic as the years go by. By the time I’m 87, I’m confident I’ll review my results with the sangfroid of an international spy.