The Surgery is Scheduled

What torture have I signed up for?

The surgery is scheduled. July 3rd is the date. It’s as real as a heart attack… or cancer.

I didn’t set out this morning to contemplate the removal of one of my organs. I had planned to dive into the idea that unstructured time is subversive — offensive even. I suspect that doing nothing is a rebellious act and one in which I plan to indulge more often. I was feeling punchy. But then the surgeon’s office called to confirm the date and my courage and puncher’s attitude faded.

The knowledge that I have cancer interrupts my days often. It knocks me back, and I have to find ways to once again screw my courage to the sticking place. This is a new ballgame and another level of fear altogether. I’ll have to find new ways to deal, and as always, that starts with collecting all the information.

One of the books I bought and devoured early in this journey is Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer. Walsh invented the radical prostectomy procedure at Johns Hopkins in the early 1980s. Technically, he invented the nerve-sparing radical prostectomy — a key and very important distinction.

Before Walsh, removing the prostate meant removing all the nerves around the organ as well — nerves that allow men to get it up. In the early days of prostate cancer surgical treatments, there was one path. Get the surgery and remove the cancer, but live with erectile disfunction for the rest of your life. The good doctor Walsh figured out how to save the boner.

Radical prostectomies, in which the organ is removed entirely, are now strikingly common procedures. Over 100,000 of these surgeries are performed in the U.S. alone every year. That’s because 1 in 8 men will get prostate cancer in their lifetimes. 1 in 54 men in their 50s get the disease (👋🏻). It’s the most common form of cancer in men by far.

Routine or not, it still seems like a pretty complicated surgery, mainly because the prostate is in a very crowded part of the male body. It’s a ping-pong size gland just below the bladder, right in front of the rectum. The organ wraps around the urethra, which is the tube that connects the bladder to the, ahem, penis. Getting the prostate out means cutting and reconnecting the urethra with micro sutures. That’s a wound you want to heal properly. Hence the dreaded catheter.

What I’ve discovered is that not many people know where the prostate is. When I told my mom about all this, she admitted that she was in the dark.

“Isn’t it in your testicles?” she asked without a hint of a tremor.

Part of the reason it’s uncomfortable talking about prostate cancer to anyone is that you have to wade into intimate anatomical details that don’t lend themselves to idle chitchat. This is ten times worse when talking to your mother.

“It’s closer to your rectum,” I said, using proper medical terminology and purposefully avoiding the term “asshole” since that would be another bridge too far.

The bottom line is that removing the prostate isn’t like getting a root canal. It’s a procedure done by robots. The surgeon makes five incisions in your abdomen. Into those holes venture robotic arms outfitted with cameras and what I imagine to be all sorts of sharp knives, saws, and other implements of torture.

The whole thing is performed by the surgeon using a joy stick at a console about six feet away from the operating table. It takes about three and a half hours. I’ll be home and walking the same day.

Anyone who has had surgery — and I once did for a torn ligament in my shoulder I acquired during a biking accident in Brooklyn in 1999 — will tell you that the surgery itself isn’t so bad because you get the good drugs and then you wake up. But I can’t get there.

I see my naked body lying like a slab of meat on a cold silver table under bright lights while robots molest my insides. I wonder if I can get the good drugs sooner.