Small Town

He didn’t wait for a response, but headed straight for the men’s room. When his bladder prompted him, social graces were a luxury he couldn’t afford. He had to respond in a hurry.

And then, of course, he would wind up standing in front of the urinal trying to trick his prostate into getting out of the way long enough to allow the stream to flow. Magically, peeing became the only thing more difficult than resisting the urge to pee. It was a hell of a thing, getting old, and the only thing that made it remotely attractive was when you considered the alternative.

Which was something he’d been forced to consider more and more lately, ever since he’d been diagnosed with prostate cancer.

Eight months now. Back in August his internist did a PSA and made an appointment for him with a urologist, and then the fucking Arabs killed three thousand people for no reason whatsoever, and he canceled the appointment and forgot to make another until his internist called him, all concerned, and got him into the urologist’s office for an ultrasound and a biopsy in early November. Both procedures were literally a pain in the ass, and they only confirmed what everyone had pretty much known from the PSA, which was that he had prostate cancer, and that it had very likely metastasized.

There were choices, the urologist assured him. You could have surgery or you could have radiation, and if you took the latter course you could have radioactive seeds implanted that avoided some of the worst effects of radiation therapy. What he’d recommend, himself, was surgery first, to remove the prostate and if nothing else make urination less problematic, followed by a course of radiation to zap whatever adventurous cancer cells might have migrated outside the walls of the prostate gland.

And then, should the cancer return, then they could knock it back with hormonal treatments. What that amounted to, he learned, was chemical castration, although nobody liked to call it that because it sounded as though they were going to cut off your balls. Which they sometimes did as an alternative, as it saved you from having to go in for the shots, and it was guaranteed one hundred percent effective. Not at curing the cancer, but at shutting down your production of testosterone, which propelled the cancer.

It also shut down your sex life. Coincidentally, Winters had run into an old friend, a law school professor in his eighties who’d still been sexually active until he’d had the shots as a last-ditch effort to delay the cancer long enough to — what, die from something else? “I dreaded this,” the fellow told him. “I thought this means the end, you’re not a man anymore, you’ve got nothing to live for. But the shots took away everything, including the desire, the interest. I couldn’t do anything, but I didn’t want to do anything. I didn’t care!”

Wonderful.

If not caring was such a blessing, he could take a fistful of sleeping pills and not care about anything.

He did some research, and the surgery the urologist wanted to do wasn’t like having a hangnail trimmed. Assuming you didn’t die on the table, you could look forward to a minimum of several months of incontinence and impotence, either or both of which could turn out to be permanent. So you walked around leaking pee into an adult diaper, and you still had the desire for sex but couldn’t do anything about it, and, the best part of all, the cancer came back and you died anyway.

He talked to two men who’d had radiation, and they both said the same thing: If I’d known it was going to be anywhere near that bad, I would never have put myself through it.

Wonderful.

“Finally,” the doctor said, reluctantly, “there’s watchful waiting. You come in every three months for a PSA, and we keep a close eye on it, and see how it goes.” Why, he wondered, did he have to come in for those PSAs? “So we’ll know how you’re doing.” But if he’d already decided that he wasn’t going to have any treatment, regardless of his PSA score? “Well, we want to keep tabs on this thing. We want to keep our options open.”

“I’ll tell you,” he said, “looking back, I’ve got just one regret. If I had it all to do over again, I’d never have gone into criminal law.” He’d waited, and the poor schmuck had to ask what he’d have chosen instead, and he said, “Malpractice litigation. It barely existed as a specialty when I got out of law school, but if I’d seen the handwriting on the wall I could have cashed in. And even if I didn’t make so much money, think of the emotional satisfaction!”

And he got the hell out of there and never went back.

He was taking herbs now, which maybe did him some good and maybe didn’t, he’d have had to take another PSA to tell. It was only a needle stick, any doctor could do it, but for what?