I AM A FIFTY-YEAR-OLD PROSTATE

Note to readers: The picture is not me. It’s there because I’m often described as walnut sized. I suppose there are worse things. I won’t let it spoil my big day, today. The big five-oh. I’m a big deal now. Big is the operative word. I’ve been living large of late, so I’ve been told. This is my story.  

Hurry up and wait.

Al’s been noticing a change in his restroom visits. Hurry, hurry. Now, wait. Stop. Start. Stop. Start. Go back again. It’s wearing on his nerves, and it’s costing him sleep. And when Al’s up, I’m up, that’s how it works. He’s tired of seeing the green glow of the bathroom nightlight, and I’m tired of hearing how tired Al is of it. It’s not so much an actual pain as it is an inconvenience, but it’s time to get it checked out.

Several miles and heavy traffic are between us and the urologist’s office, and, of course, Al needs to go. You know, go. Or at least, he sure feels like he needs to. We arrive in the nick of time, as often is the case. There is a delicate balance to consider, however. The doctor will most certainly want a urine sample, and there obviously won’t be one in an empty bladder. On the other hand, wet pants won’t be a good time for anyone. Al opts to use the restroom, then fill the tank back up. This is a tricky process. He fills a cup from the water cooler and quickly drinks it. Then another. Then he stands there scratching his chin, trying to calculate. How much can he drink to ensure a sample, but also hold long enough for the wait? It’s a challenge. Al errs on the side of making sure he’s full of water, and then regrets it every minute we sit in the waiting room, avoiding eye contact with other patients. Somewhere a trickling decorative fountain is mocking us both.

Al manages the urine sample just fine, eventually. It changes gloved hands a couple times and gets quickly analyzed. Turns out they’ve detected a small amount of blood. It’s not a big worry, but it is reason enough for Dr. Pokeman to call for an additional procedure today. “A quick peek at the bladder,” the doctor calls it, as if a quick look were possible. The eyes are the window to the soul, I’ve heard. The window to the bladder – neither of us want to think about or discuss. Instead, as the doctor performs a cystoscopy, the scope boldly going where no one has gone before, we imagine we are having an out-of-body experience. In my case, an actual out-of-body experience would be a prostatectomy, but Al and I aren’t ready to consider parting ways. I’d like to think that I’m a healthy part of his health.  The scope bumps painfully into me on the way to the bladder, and then again, during its exit. How very rude. Al, like myself, is relieved when it is over, and doubly so when the doctor announces he found no problems.

Apparently, the doctor hasn’t done enough peeking and poking around. “Let’s do a quick digital exam,” he says, which has nothing to do with music or displays. It means it’s my turn under the spotlight. What my examination lacks in fun, it will make up for in discomfort. To get to me, you need to take the road less traveled, so to speak. This isn’t Al’s first rodeo. Which is why he quips, “I know you’re behind me one-hundred percent, Doctor,” after he drops his shorts. Just like he does every time. I’d clap my hands over my ears if I had hands. Or ears. The doctor doesn’t even chuckle, just mumbles something obligatory.

It’s not like Dr. Megahand doesn’t have a sense of humor. This is the same fellow, as I recall, that exclaimed, “Look! There is smoke coming from your scrotum!” during Al’s vasectomy a few years back. Al had been in his happy place up to that point. Afterwards, he was in a very unsettled state. Still, it was a once in a lifetime sight, I’m sure. I was laughing, deep inside.

The doctor snaps on extra-extra-large purple latex gloves that portend the probe to come. Al is uncomfortable, though I don’t know why. I’m the one about to get prodded, and ultimately, judged.

It’s all quite touching. But, thankfully, it doesn’t take long. Barely enough time for Al to deliver his next joke; it was probably fifty years old fifty years ago.  “You know why gorillas have big nostrils?” Al grunts, the doctor grunts. “It’s because they have big fingers,” Al says through clenched teeth. The doctor mumbles and continues his chuckle-free streak.

“No bumps or abnormalities,” the doctor says, and I know he doesn’t mean Al’s head. Turns out, the doctor says, I’ve grown a bit lately. I’m “enlarged,” he says accusingly. So is Al, I feel I should mention. I’m all muscle. But my moving up a size means something different than buying new clothes. My growth, also known as BPH, benign prostatic hyperplasia, isn’t dangerous, the doctor assures, but it is what’s causing inconvenience and extra restroom visits for Al. I’m squeezing up against my neighbors, the bladder we visited earlier, and the surrounding muscles. This creates a sense of urgency for Al (I keep him running) and then difficulty emptying his bladder (I keep him guessing.)

So now Al and I have some whats and hows and whys answered, but what to do? Dr. Purpleglove recommends a drug called Tadalafil, commonly known as Cialis. Its purpose is to increase blood flow to certain areas of Al’s body, and to relax the muscles of the blood vessels. The second effect should allow for a smoother flow. But we won’t find out.

“CIALIS ISN’T COVERED BY HIS MEDICAL INSURANCE, IS IT?!” the smart aleck behind the pharmacy counter shouts for all to hear. Al reddens and feels the stares behind him. I’d love to pull the crass loudmouth over the counter by his shaggy hair, if I had arms, which I do not. The pharmacist in the back gives us an apologetic look, or perhaps it’s pity. “When is your day off?” Al asks the young man as he hands back the prescription. He is answered with a pause, a bewildered look, and finally the answer. “Thursday.”

Thursday, we return to the pharmacy with another prescription. This one is for Flomax, or tamsulosin. This alpha-blocker should relax the muscles of the bladder, as well as my own muscles, which I believe I’ve already spoken of proudly. Al notes drily that this drug has not been approved for use by women. Women are not known for having enlarged prostates.

The doctor had warned us of a possible side effect of tamsulosin, besides dizziness or drowsiness. It’s called … recordgraduation? Rectangulation? No, the term is retrogradeejaculation. The doctor says it all quickly, as if it were one word, possibly one syllable. “Don’t worry,” he assured, “The sensation is the same, it’s just the mechanics are different.” He then gives Al a metaphor by means of explanation, but thankfully uses no hand gestures. Al is skeptical, and comments that the metaphorical cannon firing back into itself instead of outward would certainly produce different results. The doctor gives Al a look very similar to the young man at the pharmacy when he was asked about his day off. “I’ll send you the bill,” Dr. Laughless says, guiding Al to the exit.

Here is the big picture. The future. I’m fifty today, and I plan, as Al does, to be around for quite some time. The big plan is somewhat of an anti-climax. With BPH, the doctor explained, monitoring is generally all that is called for. No further action required.

So, that’s it for now. I’m in no hurry. We can wait.

END

Final note to readers: Why didn’t Dr. Handyman call for a PSA test (a blood test that measures levels of prostate-specific antigen)? Medical opinions vary on its effectiveness, as the results can be misleading, and due to a variety of factors. Al supposes that this particular test just wasn’t invasive enough to be called for. I think he’s just a bit sore is all.