From The Editor - March 2009

By Pam Daniel March 1, 2009


A few days before thanksgiving, we were preparing for a big family celebration and the arrival of George’s 83-year-old mother from St. Lucia. We were so busy we almost forgot we had an appointment to get the results of a prostate biopsy George’s doctor had ordered after two PSA tests had come back higher than normal.

The PSA test measures a protein linked to prostate cancer. About one out of every six men gets the disease, and as a baby boomer, George was getting to the age where it often develops—more than a third of new prostate cancer patients these days are baby boomers. And because he’s black, he has a higher than normal risk of developing prostate cancer.

We knew all that, but neither one of us really believed George could have cancer. In George’s case, that’s just because he is congenitally optimistic. It may be a cliché, but as a born-and-bred West Indian, he’s always been a poster child for the attitude of "Don’t Worry Be Happy." I’m the professional worrier in the family, and I’m good at it; but George’s health is the one thing that’s never caused me any concern.

Strong, fit and practically bursting with energy, he gets lots of exercise, has never smoked, barely drinks and doesn’t even do coffee. He didn’t have a single sign of prostate problems, and when I looked up his PSA level online, it didn’t seem that alarming, falling into the high normal range.

But none of that kept the doctor from looking down at the lab report—I remember wishing he would look at us—and saying, "Well, it is cancer—and it’s fairly aggressive." The room seemed to spin, and I felt George reach for my hand. The doctor launched into an explanation of Gleason scores and treatment options—his recommendation was surgery to remove the prostate gland—and I kept nodding my head, but the only words that really penetrated were, "If we treat this, your long-term outlook is good."

Not every cancer patient gets such a positive prediction, and on the way home, George and I kept assuring each other that we were actually lucky—if getting cancer can ever be considered lucky. That night, I got onto the Internet and read everything I could about prostate cancer.

Some of the information was encouraging. Prostate cancer—or at least prostate cancer that hasn’t spread beyond the prostate—is one of the most curable cancers today. As recently as the early 1980s, 90 percent of men were diagnosed too late. Now, thanks to the quick and simple PSA test, most prostate cancer is found early, and 90 percent of those men are alive 10 years later.

But prostate cancer still kills more men than any other cancer besides lung cancer, and as many as 25 percent of men are diagnosed after their cancer has spread. The doctor’s best guess was that George’s hadn’t spread, but some of the cancer found in the biopsy was fast-growing, and his lack of symptoms didn’t mean the cancer hadn’t advanced. Still, I kept telling myself, George is a survivor. This is a guy who grew up in poverty on a remote Caribbean island and became one of the top students in the country, later working his way to America and a college education.

If one story can sum up a person, here’s his. One Saturday night when he was 18, George had made two dates—one early and one late. About 10:30, on the way to the second date, he was driving along a winding mountain road when he skidded and his car went sliding down the mountain. Miraculously, it stopped before it was completely crushed, and he crawled out, bruised but unhurt.

Far above him, he could see lights and hear voices. "That man’s kicked the bucket, you know!" someone called out. George grabbed a bush and began pulling himself up the rocky mountain, inch by inch, finally emerging into the ring of startled faces.

I had to believe he could claw his way up just about any mountain, including prostate cancer, especially since Sarasota offers state-of-the-art treatment for this disease. There are a number of excellent options here, but our research led us to robotic surgery, which is now available at Sarasota Memorial Hospital.

Less invasive than conventional surgery, robotic surgery results in a faster, easier recovery and fewer post-operative problems. Thanks to a friend’s recommendation, we were able to get an appointment with Dr. Robert Carey, who pioneered this technique in Sarasota and has performed hundreds of such surgeries.

Carey had flown in the night before from teaching at a medical conference in China. Exhausted and coughing, he looked more like a patient than George. But that didn’t keep him from spending more than an hour with us, going over George’s reports and answering our many questions. He even gave us his cell phone number, urging us to call at any time.

And though he told us we probably could postpone the surgery until after the holidays without much danger, he reminded us that George’s cancer was aggressive.

That was all I needed to hear. I wanted that cancer out—the sooner the better. A week later, we arrived at Sarasota Memorial for surgery.

Ever the optimist, George wanted to bring along a DVD player so he could watch a movie that night. He was miffed when I told him that was a bit unrealistic, but he smiled and waved while I snapped a cell phone picture as they wheeled him off to surgery around 2 p.m. The nurses told me it would all be over in a few hours, and the doctor should be out and talking to me by six.

Armed with two new books, I settled into the family waiting room and waited. And waited. Friends kept calling to check on George, but I didn’t have any news, and I was too tense to talk much, anyway. Five o’clock came and went. Then it was six. I finished one book and opened the next, but the words didn’t seem to make any sense.

I started to listen to the conversations around me. One patient had been fighting cancer for several years. They thought he was cured, but the doctors had found a large mass. The wife said she hoped it was an infection, but you could see she didn’t believe that. Another woman was wiping her eyes in a corner. A doctor came in, looking grave, and beckoned to a young couple.

Was that how Dr. Carey would look when he came in for me? What if the cancer had spread outside the prostate? What if it recurred down the road, as it had for that woman’s husband? All these people, I realized, had been just like us, heedlessly leading their lives and never thinking about the grim battles playing out in this room every day. One moment you are normal—the next you have crossed over into the subset of "cancer patient," a place you smugly and stupidly never felt you, the immortal heir of good health and good fortune, would belong.

It was 6:30 now, and no sign of Dr. Carey. The door opened, and my daughter and her friend, Megan, came in. I was so happy to see them that my eyes misted over. "We’re here to support you," Kate announced. They asked a few questions about George, then sat down and got out their cell phones. Soon they were bent over their keyboards, tapping out one text message after another. I felt a surge of intense annoyance and more alone than before.

It was now 7:30 p.m. Obviously, some horrible catastrophe was playing out in the operating room. Was George still alive?

Finally, at a few minutes before 8 p.m., Dr. Carey walked in and, nodding to the girls, took me into a little consultation room. He looked tired, but he was smiling. Surely he wouldn’t smile if he had awful news?

"George is doing great," he assured me. But he had found a lot of cancer, so much that he feared it had invaded the bladder. He had sent some bladder tissue out for testing—that was what had taken so long—but the report came back negative. Then he had to spend longer carefully reconstructing the bladder. George would have to stay in the hospital two days, he said, and it might be six weeks rather than a month before he was fully recovered—but he felt sure he was cancer-free.

I floated out of the room to share the news with the girls—how sweet they were, and how thoughtful they had been to come!

Two months later, with George almost back to normal, I’m still pretty much floating on air. No, everything hasn’t been easy, and like everyone else, we still have the economy, the state of the nation and a world of everyday worries to plague us. And yes, there’s always the chance some cancer may have microscopically migrated out of the prostate and taken root elsewhere in his body. But even on the days we squabble, we never fail to remember how lucky we are that so far, our cancer story has a happy ending.

There’s a line from a Wallace Stevens poem that keeps coming to mind: Death is the mother of beauty. It’s our knowledge that life must end that makes each passing moment so achingly precious, and as any cancer patient can tell you, cancer sharpens your appreciation of life and of each other. It’s a little late to be making New Year’s resolutions, but mine is to keep holding onto that thought.


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