I have prostate cancer, but just barely. Gleason Score 6, watch and observe, no treatment. This isn't unusual. Most men do get some kind of prostate cancer. The trick is to make sure you die with it instead of from it.
All this means I have to get a biopsy done every other year. It's an awful process, but as cancer journeys go, it's pretty mild--as long as you take the right precautions. For my first biopsy, the clinic used general anesthesia as a matter of course. No pain during, though I had some after.
For my second biopsy, though, I'd changed providers, and the day before my appointment, I asked about the anesthesia, and the nurse acted surprised. They used local anesthesia and were startled that I wanted general. I could reschedule, but the next such appointment wouldn't be for a few months. I reluctantly decided to go through with the current appointment. This was a mistake. The clinic insisted I wouldn't feel a thing after the first shot of lidocaine, but they were wrong. I felt everything, and I was yelling in pain. Through 20 core sample. TWENTY! (The usual is twelve.) The staff continued to act surprised, as if I were the only person in the world who felt pain in a biopsy. Fuck them.
So when it came time to set up this one, I insisted on general anesthetic. Again I got surprise. "Are you sure? This is usually done with local."
"No," I said. "It definitely is not. Schedule it, please."
This actually touched off a bunch of phone calls. They had to move the biopsy to a different location and coordinate with them and-and-and. In the end it was scheduled.
As regular readers know, I was abused by medical staff while under anesthetic during two different operations. This has given me a case of medical PTSD, especially when it comes to general anesthesia. You're probably wondering why I didn't just go for local anesthetic, then. The answer is ... it's complicated. I have to choose between awful anxiety and awful pain. Which one, which one? In the end, I settled on anxiety for the simple reason that incoming awful pain would ALSO give me anxiety, and I'd rather deal with just the one.
In the weeks running up to biopsy, I was okay, but as weeks turned to days, I became more and more uneasy. The two days beforehand were the worst, and I lived on Xanax. I know the anxiety is misplaced, that the kind of abuse I went through is extremely rare, that the vast majority of medical workers want to help. Tell that to my emotions, though. It always feels like the operating room staff are just waiting for me to fall unconscious so they can say and do anything they like.
Also, I discovered the clinic was planning to conduct a different (to me) kind of biopsy. My other two were transrectal. This one would be transperineal. Transrectal has a 5% rate of infection, you see, and transperineal has virtually none. But this clinic didn't mention this fact to me. It took me a while to tell myself that this was because they had dropped trans-rectal biopsies some time ago and made transperineal the standard, and most patients didn't know or care about the difference, so they had no reason to mention it. Until I was able to convince myself of this, though, I was in another anxiety overload.
A couple days before the biopsy, I emailed the clinic and briefly explained my situation: that I was an abuse survivor and came out of it with bad PTSD and white coat syndrome. In order to make this bearable for me, I wanted to be awake until just before the biopsy needles went in. After a bit of back-and-forth, the clinic allowed that this would be fine.
The night before the operation, I didn't sleep at all. Not even a doze. I stared at the ceiling all night long, unable to think about anything but the biopsy. It was a long, long night.
Finally, it was time to get up and leave. I did have the go-ahead to coke myself up on Xanax, so I did. By the time Darwin drove me to the clinic, I was a little floaty.
I also had my little device with me. It's a recorder disguised as a flash drive. It looks like a flat stick. I habitually put it inside a finger splint and use it to record all operations so I can at least hear what happened, even if I can't see it. (When I mention to medical workers that I smuggle a recorder into the operating room, they inevitably react with horror. How dare I? My response: why is it that every single person in that room gets to know what happens to me but I, the one person who is most involved, shouldn't know a thing? Again, fuck you.) I slipped it into the splint and when the nurse inevitably asked about it later, I gave my usual answer: "Yeah, I hurt my finger and need to wear this for a while." I've never been challenged about it.
This clinic didn't allow family to be anywhere but the waiting room, so I had to go back to the prep area by myself. I made sure the recorder was working and got into the gown and all that. I'm an experienced surgery patient by now, and I know it's easiest to wear slip-on shoes, a t-shirt, and jeans with no belt, nothing else. Belts and sweatshirts and glasses just turn into crap to keep track of when you're groggy. Keep it simple.
The hospital had a neat little trick--an air circulator that plugged into the gowns like a CPAP machine. It circulates warm air through the gown. This keeps the patient warm even in a cold operating room and the staff doesn't have to constantly get blankets from a warmer. Nifty!
When I was ready, the usual parade of nurses, anesthetists, and the doctor began. They were all aware of my preferences for the prep, for which I was appreciative. Most men find the prep for a transperineal biopsy to be embarrassing, but to me it's worse that someone is doing the embarrassing stuff to me while I'm unconscious and have no control. So the doctor positioned me on the table (eesh, I get nervous just typing this) and ran through the prep. It went fine. Then the anesthetist said it was time for the propofol. She administered it, I got dizzy, and then I was waking up in the recovery room. I remember asking for Darwin but getting no answer. I slept for a little bit, and then a nurse was there with a wheelchair telling me it was time to get dressed and go. I don't actually remember getting dressed (this is one of the many reasons why I hate anesthesia--it fucks with your memory and steals parts of your life), but I remember getting into the chair and being wheeled to the exit, where Darwin was waiting with the car. There were no complications during the biopsy, according to the staff. The doctor took only twelve cores, not twenty like last time.
At home that evening, I called up the recording on my computer. I skipped through the parts I was awake for, found the place where I was anesthetized, and listened. A lot of OR teams talk very little during the operation (the case where I was abused was definitely an outlying exception), and that was the case here. I heard the biopsy gun click, followed by a report from the doctor where the sample had come from, with the nurse repeating it and (presumably) writing it down. More clicks and reports, and then I was being wheeled to the recovery room. When I arrived, one nurse said to another that I had strangely asked to be awake during the pre-surgery prep. "He has PTSD or something," she said.
"Is it a control thing?" asked the other.
"It's probably control, yeah. He's probably afraid that--" here, she stopped herself. "Well, I'm not sure what he was afraid about."
"Uh huh," said the other nurse.
And that was all of it. I'm good with that. They're certainly allowed to exchange information about patient behavior in a non-critical manner.
I did tell the doctor that after the other biopsies, I got a fair amount of pain, so I wanted something stronger than Ibuprofen for a couple days. He gave me a scrip and I did get some fairly heft pain later. The pills helped.
One of the things that pokes at my anxieties about hospitals is the way they try to control your behavior. I know it's to maximize my care, but I also know that a bunch of it is overkill, and it creates feelings of enmity with me, and I try to work against what they tell me. For example, this particular clinic said that before the biopsy, I should avoid sexual activity for a week before and for a week after. Two weeks total! I'd never once heard about avoiding sexual activity before a prostate biopsy (before a PSA test, yes, but not before a biopsy), and I surfed all around the internet to check on this. No urology clinic I found had a cessation of sex in their pre-op instructions. As for after, they said to avoid sexual activity for three to five days. Not a full week.
I'm putting a chunk of this behind a cut screen because it gets very biological. I cope with this stuff by writing it down, which is why it's here. But you can skip it.
( Read more... )Okay, we're back from the cut. A couple days later, I got an alert that I had new results in my patient portal. Oh yeah--what was the cancer doing? Weirdly, I had been more freaked out about the idea of having a biopsy than I was about the actual cancer. But the alert made me suddenly uneasy. I knew the results would be written in medicalese, but I'm fluent in that language thanks to growing up in a medical family, so I knew I'd be able to read them. Nervously, I called them up.
All twelve cores came back as "benign prostatic tissue." In other words, no cancer anywhere!
I joked at the last biopsy that the all the needles were snatching the cancer right out of there. Now it seems to be true! In all seriousness, though, it's very doubtful. The needles just missed any cancerous tissue. But that would also mean the cancer isn't spreading. I'll confirm with my oncologist at our appointment next week.
At the moment, I'm not feeling any pain from the biopsy, and I'm hoping the other side-effects are gone. I also got through it without melting down. We'll call it a win!
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