For the chop
Just before Christmas Simon Wilson was diagnosed with prostate cancer. Here’s part five of his diary. Warning — contains graphic surgery descriptions.
Just before Christmas Simon Wilson was diagnosed with prostate cancer. He’s been writing about his experiences in a weekly diary. Today, in part five, he prepares for surgery. And warning, you will squirm.
Surgery used to be done only if you would die if it wasn’t done and then you usually died anyway. They’re better at it now, but it will always be that serious.
They will slice me open from belly button to penis, a long straight cut, the blood spilling, the two deep folds of flesh prised apart and everything forceped and clamped, to keep the site as open and clean as possible.
Mr G, the surgeon, will sever the urethra, more clamps. He will slice around the prostate gland, which is about the size of the palm of my hand, and around part of the right-side seminal vesicle attached to the prostate. He will do all this with a generous margin of other tissue as well, to try to make sure he gets it all. He will take some lymph nodes from both sides. He will cut as cleanly as he can and they’ll send it to the lab. He wants more tests.
He will be working close to the rectum and will have to be careful not to pierce it. If he does that, it’s messy, not just to clean up and to fix up, but afterwards. A high risk of infection. There will be blood.
He will reattach the urethra and hope it takes. He will reattach and fold back everything else. They will run a catheter up through my penis into the bladder, and then inject a little water into it, so it forms a bladder in my bladder, which will stop it falling out. That’ll be there for up to 10 days.
They will sew me up. The whole thing will take three hours.
I will emerge from the anaesthetic but I won’t feel pain, because they will have injected morphine near my spine. I won’t feel a blessed thing for 24 hours. Then I will.
I like to think I will have a pretty good scar.
the last things. You try not to think of them as the last things, because you want to stay in the moment and because it’s depressing to think you won’t be doing this anymore. Not only that you won’t be doing it but, worse, more utterly bleak, you won’t be feeling it.
I’ve had medical procedures before. A spinal injection, twice, for back and leg pain. That was a local anaesthetic and you lie very still or they’ll paralyse you. That snaky black tube they push down your throat to look at your stomach and guts, I’ve had that too and my god it’s hideous. You lie there trying not to move, retching. Three times, I think. Turned out I have reflux, nothing worse.
But I’ve never been admitted to hospital, for any reason. Never had my body cut open, never broken a bone, never been on a serious medication. Didn’t even bother with the reflux pills, kept it at bay with what I ate. Saving myself up for this.
You do the last things and what might be important things. I went to Waitangi and wrote about it. It was thrilling, and I had not expected that. I wrote about how charged it was, how great the sense of change was.
Was that change real, was it history in the making? I don’t know and nor does anybody else, because it’s too early to know. Maybe Waitangi this year was the harbinger of a new way we function as a society and I will always feel lucky to have been there. I will write about it and be very pleased to do so.
Maybe it wasn’t, and the promises were false and the spirit of the occasion will be betrayed. If so I will write about that too.
It will give me no pleasure at all — who would take pleasure in such a thing? — but I will do it.
Most likely the truth will be somewhere in the middle and there will be lots to write about and argue about too. I just have to get this other thing out of the way first.
I want to say, by the way, that if there is an award for the most perfect EP ever it should go to Christchurch’s Reb Fountain and her country album Hopeful Hopeless. I drink it down and am never sated. I suppose it will pass, it always does, but it hasn’t yet.
I’ve been down country. I stood on the shore of Lake Taupo in the evening, at a beach whose location I will never divulge because it is not signposted, not well-known and beyond beautiful. There’s a heron that walks the water’s edge, intent on spearing the little fish. If you’re very quiet and still, it walks right past, just a couple of metres away.
I stood on that shore in the warmth of late summer, waiting for the sun to emerge. The water was flat, infinitely grey, gleaming. I’d had two swims already and now, deep into the evening, the sun was low and obscured by thickening clouds and it was obvious, then likely, then possible, then not impossible, that it would come out one more time. And I would swim, one more time. And it did, and I did.
You do the last things.
IN THE last week before the surgery they call you in and put you through the stations of the pre-op: up one floor for an ECG for your heart, corridor for your basic measurements, nurse’s cubby to explain the procedure, pharmacist in the waiting room to check on meds, anaesthetist’s cubby to talk about how well you are, surgeon to skip through the procedure, bloods because for some reason they haven’t got round to finding out what blood type you are. You give your date of birth at every station, and then it starts.
They’re so friendly, so supportive, and they’re obviously so busy but they make the time to care. And it’s great, until you start to think, is it like this because something really bad is going to happen?
Except something really bad is not going to happen. I’m going to recover well, almost certainly, and I’m going to live for quite a while yet, fairly probably. But a general anaesthetic is serious business, and so is cutting me open from midriff to kingdom come and slicing out a big diseased chunk of me and patching the remains back together.
Surgery used to be done by butchers. Surgery used to be done only if you would die if it wasn’t done and then you usually died anyway. They’re better at it now, but it will always be that serious.
I remember my mother, lying in a hospital bed shortly after hip surgery, all the muscles in her face completely relaxed, so that her skin just sunk to the lowest points and lay limply over the skull. It was frightening.
I remember my grandmother, dying in a hospital bed, and no one had come round to tend to her appearance. She had big hairs sprouting from a mole on her chin. I was too young to know that could happen.
Adults, middle-aged adults and older, know these are but little things. But they shock you at the time and you don’t forget. My children are adults now, but what will they see and remember?
NURSE F sat me down and gave me a lot of brochures to read. Then she reached into a cardboard box and fished out a plastic bag with hoses and straps and plastic valves, and said she would demonstrate the use of a catheter.
She had a little cutaway model of a male human, waist to thighs. It goes in here, she said, waving her hands over the model in a way that dispensed with the need for her to name any body parts. Here’s the syringe that blows in water. She showed me, holding the end of the catheter, now with a little round bulge, against the cutaway of the human bladder.
There was a day bag, which you strap to your leg “and no one will ever know”. There was a night bag, at the end of a longer piece of hose, which you attach to the bottom of the day bag and lie it on the floor by the bed.
I thought, do you get tangled up in the hose? How common is it that the whole thing just comes adrift and sprays urine everywhere? I couldn’t see that any good would come from asking these questions, so I didn’t ask.
I said I didn’t know much about side effects from the operation. Nobody had talked to me about nausea, for example.
Oh, nausea, she said with a dismissive wave, and I thought for a moment she meant it would not be a problem.
Everyone gets nausea, she said. Don’t eat too much too quickly.
What about alcohol?
Oh! she said, and took a deep breath and placed her hands on the desk. She swivelled to look straight at me.
Don’t.
Very dramatic. I said, why not? Because it is bad for you.
Yes but is it especially bad after surgery? She paused.
No.
I was surprised. I totally would have believed her if she had said yes. I still assume she should have.
She told me I had to do pelvic floor exercises and gave me a brochure explaining what that meant. If this was an antenatal class, I thought, we’d all be practising by now.
She gave me another brochure about incontinence, with an elderly gent in a wetsuit staring hopefully into the distance and holding a surfboard. All things are possible, was the message, or just possibly, you’re going to be so incontinent now you’ll have to wear a wetsuit all the time.
As I went from one station in the pre-op to the next, she said, there would be gaps. Periods when I was just waiting.
I have some advice, she said. Use your time here wisely.
I liked her very much. I went back to the waiting room to contemplate what she meant.
The surgeon, Mr G, was full of good cheer. He bounced straight in. His principal aim was to cure me of cancer. He put it exactly like that.
He hoped also that I would have restored urinary function. I might even have some erectile function. I was so tired of hearing all this. He said he expected I would be injecting myself. That was new. I suppose I had thought pills. He said I would have orgasms but they would be dry. I had not thought about that either.
He said the alternative, hormones and radiotherapy, would leave me with no erectile function at all. No performance and no desire either. That was new. But if my treatment is fully multi-modal and they end up doing it all anyway, what will that mean?
I asked him what’s the difference between a radical prostatectomy and the radical radical prostatectomy he was going to do to me? The radical operation would be keyhole surgery, he said breezily, possibly with a robot arm. They reach in and scoop it all out. The outcomes are usually pretty good, relatively speaking.
He told me they do so many radical prostatectomies now, maybe they do too many. They get in early but is it too early? Would some of those men be better off without surgery? Would the resources be better used for patients like me, who really do need it?
He said men are presenting earlier and we aren’t dying so much anymore and they can’t keep up. They’d just had to put on six extra clinics. Prostate cancer is becoming a chronic condition to be managed.
Then he started to think about my situation, where the average outcome isn’t as good as that. There are averages but they don’t always mean a lot, he said. We want to get an outcome for you that’s better than average.
It was the last thing he said. I went back to work. A few days later I had the operation.
Simon Wilson had surgery for prostate ● cancer on February 27. He has been recovering at home and will shortly return to work. Next week: after the operation.