Simon Wilson started a new job as senior writer with the Herald last month. But one of the things he'll be writing about came as a big surprise – to us and to him. Wilson has discovered he has prostate cancer. Here's part one of his diary.
1: The day the phone rang
Your bloods are back and they're all good, said Dr A on the phone, and I was just about to say oh good when I realised she had left a very slight pause. So I waited, and she said it: but the PSA was high.
It was 40, she said, which I knew without having to know was very high.
She'd found nothing with her finger, the day before. Now she wanted me to see a specialist as soon as possible. Like, tomorrow.
The PSA, the "prostate-specific antigen" test, is the blood test for prostate cancer. It's one of two diagnostic tools doctors use, the other being a digital exam, which is a euphemism for them sticking a finger up your bum to feel the size and texture of your prostate gland. All older men should get them both done regularly; also younger men deemed at risk through family history.
• Part 2: A urethra runs through it
• Part 3: What you keep, what you lose
• Part 4: To cut or not to cut
• Part 5: How the surgeons will slice me open
• Part 6: A pretty good scar
• One year on: Into the blue
That's me. I have family history. But I haven't had it done often enough: this was my third digital exam, and I thought I'd had a PSA before but my current doctor has no record of it. Before last month, I hadn't even had a check up for quite a while. I was stupid.
It was the morning, Dr A's call had come while I was walking down the street on my way to work. I asked, should I come in and see you now? No, that wouldn't be necessary. Oh, okay then.
She rang back to apologise and say she might not have handled that very well. I was very welcome to come in. Perhaps she should not have told me on the phone.
No, I said, it was fine. I thought, there's no right way to have this conversation, is there?
I asked her, is there anything more for me to know at this point? She said no, not really. So I said no, I won't come in.
This wasn't the plan. It was two weeks before Christmas and I was starting a new job in the new year – this job, at the Herald. I'd gone for a general check-up because my old GP had retired a year earlier and I hadn't needed to see a doctor since, so I hadn't even met the new one and I wanted to do that. The immediate issue was I had earwax that needed syringing.
Yes, if you want details, I had the classic prostate symptoms and I knew about it: my urinary flow is not as – what's the word? – robust as it once was, and I need to go more often. No, I am not one of those men who stand wide-legged at the urinal, their gushing declarations of confidence revealing they have no idea anything could ever change.
So what, I had been telling myself. It happens to most men and mostly it's not a symptom of cancer. I have a hundred little symptoms of being older than I used to be. They don't mean I'm dying, ha ha.
Although, is that honest? I have a hundred little symptoms and maybe they add up to a critical mass of illness and disease that I'm way too scared to find out about.
I'm not uncommon. At a certain age, and then at another age beyond that certain age, don't most of us hold both these ideas in our heads – we're fine and we're mortally ill – at the same time?
Ageing means putting up with physical inconveniences. The best way to deal with aches and pains is to refuse to let them slow you up.
Also, ageing means a door opens to reveal a desert – or an ocean, a jungle, whatever works as your own special landscape of fear – and you are forced to consider the prospect that something you glimpse moving around out there will one day kill you. So you hide from it.
Of course I didn't go to the doctor earlier – what good could come of it? I had waited, not till I needed to go, but till I felt really confident. I'd had a very good year, work-wise, and expected to start an even better one. I was about to go on holiday.
Dr A texted me a bit later the same day: my wife and I were very welcome to come in for a talk. So P and I went in late that afternoon. It was a kind of bonding thing for me and the doctor, more than an information thing. She didn't know the answers to some questions, procedural things, but made calls and got them on the spot.
I liked her a lot. I read once that age affects a doctor's ability to diagnose accurately in a counter-factual way: you'd think experience would help, but it's the reverse. The more recently a doctor graduated, the more likely they are to know what's wrong with you.
I don't care. I don't even know if I believe it. Dr A is roughly my age, probably a few years younger, and she is friendly, with a goofy charm that comes from knowing what it's like to be our age. Well, that's what I choose to believe.
Is goofy charm helpful in a doctor? Of course it is. You don't need your GP to be Gregory House. Although when you have an illness that could kill you, you do hope someone else in the system fills that role.
It was Wednesday. I don't have health insurance because I don't believe in it. But Christmas loomed and Dr A and I agreed, let's try to get an accurate diagnosis, at least, before then. She booked me in for a biopsy with a private specialist on the Friday.
Thursday was the office party where I worked, an all-day affair where we had to run around town all morning doing team-building games, before ending up at a venue in the suburbs to open Secret Santa presents, make lovely speeches about each other and drink the afternoon away. I liked it a lot, in an I-will-never-do-this-again-in-my-life kind of way. In the middle of my own farewell speech I may have burst into tears, but that was entirely because I was sad to be leaving. Also, I was itchy all day.
When I woke the next morning my face had swollen up. I looked really terrible, all the flesh near my eyes puffed right out, and I was sunburned. And still itchy. It was the antibiotic I'd been taking since Wednesday evening to ward off a possible infection from the biopsy to come.
So there was coming and going about that, and a new antibiotic chosen and taken in one massive dose. That afternoon P took me to see Mr B, the urologist, in the labyrinthine building of a private hospital, where you walk past the rooms of a dozen specialists in one field or another and every single one of them has their own receptionist.
Mr B was splendidly reassuring, right from the start and right through the whole procedure. He was so nice. Although at a certain point I realised – I think it was the moment when he referred to my PSA result by saying 43 is very high – that he'd be just as reassuring if he was telling me I had only a week to go. I tried not to think about that. I tried not to think about anything.
I didn't go into shock, even though I'm terrified of dying, of not doing the things I want to do, of all the pain and endless debilitation that comes before it goes, of the misery I will visit on my kids and my wife – I assume it will be misery – and of the idea the world will go on without me.
I don't think getting older helps you adjust to the idea. It just makes the prospect more immediate.
But I did not go into shock and instead I did my best to match Mr B's niceness with my own. Besides, there was no prognosis yet.
He did the finger test and then we got ready for the biopsy. He would take between 8 and 13 samples, he told me, depending on the seriousness, and he ended up taking 10. It hurt, but the worst was the numb bruised feeling as the anaesthetic wore off. Just like when it's your teeth, except it's up inside your arse. Very nicely, Mr B called it my bottom.
What actually happened is that I curled up on the bed, pants off, and he inserted a tube into my bottom with a camera and a contraption like a micro-nailgun attached. This he fired into the prostate gland, a round smooth thing behind the base of the penis, although in my case, apparently, not smooth but rough on one side, and wider and flatter than it should have been. The urethra runs through it, and is constricted if the prostate has enlarged. Hence my urinary problems.
The contraption has a needle with a groove in it and a sheath around it, and it takes a two-centimetre long, one-millimetre wide piece of you, which sits in the groove and is then drawn out, while the main device remains in place. Repeat, nine more times.
It's not painful, to start with, and then the third or fourth time it is, and the next time more so, and it keeps climbing after that. It's not awful, but at a certain point you don't want to be thinking there are three more to go.
You try to relax as required, but without letting your bowels go, because it feels like they want to. Right throughout, Mr B asked me about my work and we had a friendly and extremely civilised conversation about the state of the media today.
Then you sit up, and then stand up. Mr B and I stood there, face to face, less than half a metre from each other, continuing to chat about the future of newspapers, him dressed in neat comfortable clothes and me in only my shirt-tails and a pair of socks.
He said I do think it's cancer. He also said it's quite likely they've caught it early enough for me to be cured. I couldn't read whether to believe him. He wrote URGENT on the lab instructions because it normally takes 10 days and that would take us exactly to Christmas Day. He hoped we would hear within the week. Treatment could start before new year. Obviously, it was serious.
The 10 biopsy samples, five from each side of the prostate, floated in fluid in their plastic specimen containers. They looked like the little worm I had found in the peach I cut up for breakfast that morning, only the worm was bigger.
• Part two of Simon Wilson's Cancer Diaries will appear in the Weekend Herald next Saturday.