When you wear the big bag, you have more of a pulling sensation because, obviously, there is considerable weight on the other end from both the bag itself and the urine it’s holding. You don’t have that when you wear the small bag, but then you worry about potential spillover. That did happen to me once. Fortunately, I was in my bedroom, not in the public library.
Catheterized, you exist in a kind of purgatory, between epochs—BC (Before Catheter) and AD (After Displacement). When you’re awake, you have the constant fear that it’s coming out, and when you’re asleep you dream that you’re driving through West Virginia, it slips out, you pull over, and a gas station attendant who resembles the banjo kid in Deliverance has to reinsert it.
On my third day with the catheter, I got a call from a friend, Mike Caruso, a former three-time NCAA wrestling champion, who one year earlier had undergone a robotic prostatectomy with Dr. Lee.
“You doing okay?” he asked.
“Yeah, but this catheter sucks,” I said. “It pulls at you and it seems like all I do is change the bag. Or my wife does. I gotta tell you, it’s no picnic around here.”
“But you get it out soon,” he said. “And that feeling? I can tell you it’s better than winning Nationals.”
CHAPTER 10
... In which the author celebrates catheter removal, gets his postsurgical pathology report, and skulks around in search of pads
THE PERIOD IMMEDIATELY FOLLOWING SURGERY feels like a regression in time. You become a child, every minor accomplishment a triumph, every bodily-function milestone a joyful celebration.
“Oh, that’s a good burp. Are you starting to feel better?”
“Oh, you just passed gas. Wonderful!”
The first post-op bowel movement is the most significant milestone. They frequently forget to tell you at the hospital that painful constipation can be a consequence of the terrible triad of anesthesia, pain medication, and mostly being flat on your back, but I am a post-op veteran and was determined it was not going to happen. So in the days immediately following my surgery I stayed away from protein and all but starved myself on a diet of soup, juice, and water. You don’t know what a sacrifice that is unless you’ve seen me perform a graceful pas de deux with a plate of sausage. I took short walks constantly, wearing baggy sweatpants and waving jauntily to my neighbors with one hand while using the other to check that my catheter was still engaged.
With the help of stool softeners—do not abuse them, but for God’s sake don’t ignore them—I had the bowel issue worked out four days after surgery. As I congratulated myself, I noticed I was bleeding at the tip of the catheter. I called Keith, my urologist. Here’s what his life is like: He picked up, having just come out of the operating room for an emergency procedure. It was nine o’clock on a Friday night.
“A little bleeding is natural,” Keith said. “It comes from straining. Obviously if it continues, give me a call. But you’ll be fine.”
It stopped. And to be honest I didn’t have a major catheter issue. I kept moving constantly; one night between 1:00 and 2:00 a.m., I trekked a path around the bottom floor of the house 137 times. I counted. It passed the time. So did Law and Order reruns, which I began to imagine were an homage to Jerry Orbach—who played Detective Lennie Briscoe—a prostate cancer fatality.
No matter how you pass the time, you never forget that the catheter is in. It confirms, by its very existence and positioning, one of the male’s worst fears—that his penis is shrinking. You are supposed to check the catheter area from time to time to see if it’s black and blue, which means you’re constantly looking down, which means you see the catheter seemingly pushing your penis farther and farther into your body.
Plus, there’s this: Your member might, in fact, actually be shrinking. A University of Miami study found that in nearly 20 percent of prostatectomy patients, penile length decreased by at least 15 percent. You know how you’re supposed to “do the math”? I don’t want to do the math on that. Dr. Lee theorizes that shrinkage could happen over time because of poor circulation during that period when men are not having erections. “The oxygen content gets so low it’s scary,” he says, “and if that state continues for a year or 15 months, that tissue stays firm, not spongy. So when a guy has an erection it stays more contracted.”
I’ve noticed a burgeoning cottage industry in reporting on the possibility of reduced penis size and there is still much research to be done (if anyone really wants to take it on). A link to one theory about it is listed in the Sources and Resources section at the back of the book. But the message from urologists seems to be a positive one: Use it or lose it. My wife tells me that something similar is conveyed to menopausal women by their gynecologists. How nice it is when sexual missives actually intersect in the marital ether.
During a day of Googling—one tends to spend a lot of catheter time Googling—I came across a Web site on which men and women talked about enjoying sexual activity while their Foley catheters were in. Perhaps I was getting conservative in my old age, but that didn’t spark even the slightest bit of curiosity.
The real sexual questions were going to emerge after the catheter did.
WHICH IT DID EASILY AND WITH A QUIET SNAP that was one of the most blissful sounds I ever heard. The balloon at the bladder end of the tube is deflated before extraction and there’s nothing to it. Kelly Monahan—Dr. Lee’s PA, whom you remember from Leonard Collier’s operation—said it wouldn’t hurt, and it didn’t. It had been in for eight days. It felt like eight years, but now it was over.
“Tell me something, Kelly, and I mean this sincerely,” I said. “What’s a nice girl like you doing in a place like this?”
She laughed. So did my wife, who was along for the appointment. Kelly said she enjoyed the whole urology package—assisting Dr. Lee, who appreciates her input, the team approach, the buzz of the OR, being able to prescribe medication, giving men and their partners positive news, which she says is what she mostly does after Dr. Lee’s robotic prostatectomies.
She said she had some for me, in fact.
“I have your post-op pathology report,” she said. “Let’s see . . . your prostate weighed 39.7 grams [about 1.4 ounces]. That’s about normal. The pathologists biopsied the gland and your Gleason was 3 + 4. That’s a little change, just a little worse, from the 3 + 3 pre-op. You had clear margins, but the cancer had advanced near the capsule.
“When your prostate came out it was in one big piece with the seminal vesicles attached. Pathology covers the whole thing with ink, which then represents the margins. We want the margins to be clean. Cancer sometimes invades the seminal vesicles from the prostate and can spread outside of one or both. That produces a positive margin. But yours were negative. You are cancer-free.”
I don’t care how low your level of cancer was, how confident you were going in, or how much somebody said that you didn’t need surgery—hearing the words “cancer-free” will make your day. And the fact that my cancer was one Gleason point more serious, as well as a little closer to the capsule, i.e., the outer edge of the gland, made me feel better about having gotten it out.
Kelly explained—though we’d already known—that any future orgasms would be dry since the semen-manufacturing vesicles had been hauled out with the prostate. She suggested waiting two to three weeks for sexual activity. “We encourage it after that,” she added, “because it will help the healing.” Dr. Marvin Gaye advocated a similar “Sexual Healing” treatment, and by most accounts took his own advice.
“So it was a good report,” continued Kelly, “and I’m glad you had your prostate removed. So is Dr. Lee. You should feel the same way.”
“I do,” I said. And I did.
The rest of the discussion centered on pads, so much talk about pads that I could’ve been at a training session for Kotex salesmen. “Leakage can be a real problem,” she said. “Some men tell me they use one pad every other day, others have told me they go through six or seven a day. Did you do your Kegel exercises
before surgery?”
I could’ve said that I was the Kegel King, but I told the truth.
“I’d give myself a C in that department,” I said.
I don’t have a reason for not having been better at it. I could tell Kelly wanted to give me a lecture, but, hey, I just spent eight days in Catheter Incarceration.
Then she released me with this chilling admonition: “We want you to urinate as soon as possible. If you can’t, if you have urinary retention, you should go to the emergency room immediately. About 2 percent of men have to be recatheterized.”
“Excuse me?” I said. “Recatheterized? When you’re awake?”
“Some men are unable to urinate,” she said. “There’s a blockage. It probably won’t happen. You should be fine. But don’t delay doing something about it if it does.”
My wife and I thanked Kelly and immediately adjourned to the hospital cafeteria, where I drank enough water to quench the thirst of the entire Kentucky Derby starting field. You’re familiar with the expression “piss like a racehorse”? That was my intention.
But not my outcome. I stood over the hopper for a minute or two as thoughts of recatheterization and images of the Deliverance kid wearing a hospital orderly’s uniform came into my head until . . . something appeared to be happening. I couldn’t feel much of anything—the nerves still were not back—but I was urinating, slowly and anything but surely, but doing it for the first time in eight days on my own. Not much came out. But whatever came out felt wonderful, if only as a psychic release.
I placed a phone call to Mike Caruso when I got home. “Congratulate me, Mike,” I said. “I just won Nationals.”
AS A TEEN, YOUR HEART BEAT like a tom-tom when you slipped that copy of Playboy in between the daily newspaper and the sports magazine, and when you tried to hide that package of condoms amid an unholy assemblage of gum and candy bars. So one of the joys of getting old is that you’re not generally embarrassed during shopping.
Unless you’re a post-prostatectomy victim on your first excursion for pads.
“Can’t you just buy them for me?” I said to my wife.
“I don’t know what’s right,” she said, no doubt flashing a secret smile that meant You never shopped for my pads.
Pads, pads, pads, pads, pads, pads, pads. Every prostate questionnaire I filled out before and after surgery included questions about urination—Drippage? All-out leakage? Feelings of not being finished? How soaked are your pads? Minimally soaked? Utterly soaked? Desperately, existentially, Nietzsche-level soaked?
I had gotten dire warnings about control issues. One man called my house and admonished my wife, “Be sure to get those waterproof protective pads that go between the bottom sheet and the mattress pad. You’re going to need them.” He sounded like a meteorologist describing a particularly powerful and unpredictable monsoon heading for shore.
From the beginning, though, I felt fairly confident that I would be continent. But I couldn’t be sure, so after getting my catheter removed my wife and I headed to the store.
My sons had named their high school band Aisle Nine after a song they wrote about that overlooked lane in the market where all the strange products were kept—Spam, off-brand candy, particularly revolting species of canned fish. The pads are near that area of Wegmans, in a far corner under a sign identifying the entire section as INTIMATE CARE and specifically INCONTINENCE. It was the section where you didn’t want to meet any of your friends who might be passing by on the way to the nearby PAIN RELIEF section:
Hey, Jack. Listen, I heard about your cancer. You doing okay?
Sure, Bob. Doing great. I’m looking for avocados. Gonna make some kickass guacamole.
Right. But they’d probably be in produce, all the way at the other end of the store. You’re in the incontinence section.
Oh, hell, didn’t even notice. Thanks.
My wife and I perused the sad offerings. The products had names designed to inspire confidence. Depend. Poise. Prevail. Certainty. The euphemistic coyness made sense, I suppose, being much better than a product packaged as I Might Be Peeing Right Now but You Wouldn’t Know It. We finally settled on a box of pads, a box of smaller guards, and the climax to this dispiriting trifecta—incontinence briefs, an oversized something that looked like they were made for a laugh line in an Austin Powers movie.
“These are kind of like what Oliver wears,” she said, speaking of our 2-year-old grandson, who was going through potty training at the time.
“I’m announcing right now that those will never come out of the box,” I said. “If it comes to the point where I have to wear them, I will stay inside. I will become Howard Hughes.”
My wife didn’t have a lot of sympathy. “Imagine being a 12-year-old girl and hearing your mother explain, ‘Pin these to your underwear, and by the way you’ll be bleeding for the next 40 years.’ So stop complaining.”
So I stopped complaining.
Each morning for the first couple of weeks after the catheter removal I dutifully put on the big pad and felt like I was walking around with a banana between my legs. I was in sweatpants most of the time. I took the pad off at night and threw it away and except for minor exceptions the pads were always dry. Then I moved to the smaller pad, and after a few days I didn’t wear anything.
I got lucky. I am not taking credit for having urinary control after surgery, because I had cheated on my Kegel exercises. I give credit for my success to Dr. Lee and to the fact that I hadn’t been incontinent before surgery.
We eventually donated all the pads and guards to a prostate support group, except for a single pair of the Austin Powers briefs. You never know when you might need something for Halloween.
CHAPTER 11
... In which the author rejects Levitra, finds Cialis, puts his oars into different sexual waters, and finds satisfaction, if not fireworks
IN MY CATHETER-REMOVAL DEBRIEFING, Kelly had not said much about a timetable for the return of sexual function because there was not much to say. It’s a mystery. The nerves responsible for erections are not in the prostate, as was once believed. Rather, they are located on each side of the prostate. They run along the urethra and come out into the pelvic area and the penis. If both nerves are damaged or removed during treatment, a man probably won’t be able to have an erection without the aid of medication or some kind of device. Spare one set of nerves or both and a man has a decent shot of regaining good sexual function, depending, of course, on his age and potency going in.
Surgeons will give you a fair assessment for the return of function, but “fair” is about as far as anyone will go. No surgeon, no matter how confident, is going to march in and proclaim: “Nerve sparing was complete. Tell your partner to start microwaving the lotion. You’re about to get busy again, playa!”
In my case, Dr. Lee shaded toward optimism about both continence and erectile function. “A human being’s peripheral nerves are covered by a strong, fibrous layer that protects them from injury,” says Dr. Lee. “When you hit your funny bone it hurts, but your nerves don’t die. Well, the nerves that control unconscious things like bladder and erection function don’t have that same kind of covering. So any kind of stretch, pull, or tearing makes them a lot more susceptible.” Nevertheless, he still envisioned a positive outcome for me.
As part of the post-op reboot of the reproductive system, Dr. Lee’s urology group prescribes daily erectile dysfunction medication. It’s not designated for immediate sexual activity, but, rather, for aiding in the long-term return of blood flow. Their prescription for me called for a 20-milligram (mg) dose of vardenafil (Levitra).
I didn’t have too much experience with ED medication except for a few liaisons with sildenafil (Viagra). It worked okay, but gave me severe nasal congestion.
“I’m not going to do this anymore,” I told my wife.
“That’s fine,” said Donna, a retired teacher. “You sound like one of my sniffling second-graders in January.”
Mostly I knew ED m
edication from its inane advertising campaigns. Couples fox-trotting in the kitchen. Couples on a porch swing giving each other touches freighted with meaning. Couples lounging al fresco in . . . different bathtubs? How is that supposed to work exactly? Mutual telepathic masturbation? In one Cialis (tadalafil) spot, the bathtubs are replaced by inner tubes, which would make mutual telepathic masturbation even more difficult, water being a poor frictional conductor.
When those commercials first came out, several politicians were offended—or pretended to be—by the suggestiveness of the ads. The FDA banned a couple of the ED ads, which they labeled “misleading” because they failed to disclose major side effects.
And if you think there can’t be major side effects, you weren’t with me on the night of March 1, 2012, after I took my first 20 mg dose of Levitra. Congestion so bad I had trouble breathing. Parched throat. Severe headache bordering on a migraine. Hot flashes—go ahead and laugh, women—so intense that I felt like I was being incinerated. It was much, much worse than any of the eight nights I had experienced with the catheter.
I called Kelly. She had never heard of a reaction that severe, but she did note that men react differently to similar dosages of similar drugs. No one knows why. It’s just another of life’s delicious mysteries. She switched me to a 5 mg dosage of Cialis. Since then it’s been fine, though I continue to favor shower stalls over bathtubs.
ON A DARK LATE-WINTER AFTERNOON, candles and incense burning, I made torrid love to my wife.
“You’re incredible,” she said, her head resting on my strong left shoulder. “It’s like nothing even happened to you. It’s like you’re 30 years old again. It’s like you’re . . . you’re . . . Superman.”
Then we fell asleep in each other’s arms, waking only to start over again and . . .
The Prostate Monologues Page 9
