It was July in the Sacramento Valley, meaning that by afternoon it would be 100 degrees. Right now, at ten in the morning, it was a mere 80. I’d said good-bye to my wife before I left and she assured me everything would be all right. She’s always been an optimist. I was driving from my retirement community to a doctor’s appointment at my HMO, which stood for Health Maintenance Organization, although some would say that Health Mismanagement Organization was more appropriate. Inside my car, with the air-conditioner on, it was cool, but I was sweating anyway. If I’d kept my mouth shut I wouldn’t be going to see this doctor. What had I gotten myself into?
It had started with a piece of bad news, one of the fellows in our community’s tennis club had been diagnosed with prostate cancer and in a few weeks he was gone. This had led to a discussion among our tennis group in which it emerged that almost everyone had some problem with the prostate. Several had already had surgery and others were having their PSA tests monitored. I’d been getting up more often at night to go to the bathroom and it occurred to me that I too should have my prostate checked.
The next time I saw my regular HMO doctor I asked him about this. He gave me what is known as the digital test and said my prostate felt pretty big. He prescribed some pills that might reduce my nightly bathroom visits, and he ordered the PSA test. In about a week the test reading came back, a little elevated. In standard HMO procedure, I was going to be referred to a specialist. In an HMO, this was liked being booked at a police station; I was in the system. A couple of my tennis friends had recommended a Dr. Hardcastle and now, after a wait of only two months, I was going to see him.
After driving around the HMO parking lot for ten or fifteen minutes, par for the course, I found a space. As directed, I went to the second floor of the hospital and went through the usual registration process. I paid ten dollars for the doctor’s visit; a few years ago there’d been no charge. I took a seat in the waiting room along with a bunch of other people. The HMO was doing a good business that day. I’d brought along a book as I always did, knowing that at least a half hour wait was obligatory at the HMO, but I couldn’t concentrate on reading. I’d Googled “prostate cancer” on my computer and the information I’d gathered wasn’t too encouraging.. I wanted to see the doctor and get it over with, although I knew this was not the way it was done.
After about 40 minutes, a nurse came out and called my name. The nurse, her name tag said she was Courtney, gave me a cheerful “hello.” I didn’t respond with much enthusiasm. I followed her into a cubicle and sat up on a table while she took my blood pressure. “My pressure is always high when I see a doctor,” I told Courtney.
She said, “Hmm.”
“What was it?”
She told me. It was high, even more so than usual. Well, what did they expect when a guy was waiting to find out about something like this?
“The doctor will be in to see you shortly,” said Courtney. “Take off your shirt and pants. He’ll want to examine you.”
After she left, I took off my shirt but not my pants and I slid off the table and sat down on the one chair in the room. The nurses always wanted you to strip down and wait in a cold room. It was the HMO way.
I picked up my book and tried to read again. I still couldn’t get into it, although my eyes skimmed over the words. Time trickled by while sweat trickled down from my armpits. Why put you in one of these little cubicles when they knew the doctor wasn’t ready to see you? I’d rather be sitting, with my clothes on, in the waiting room where at least the chairs were more comfortable. Again, it was the HMO way. I looked at my watch frequently as if I could make time speed up. This was taking far too long, even for an HMO. Where was Dr. Hardcastle? I was beginning to develop a strong dislike for the man.
I was about to go out and see if they’d forgotten about me when there was a discreet knock on the door and a big man came in. “Sorry I’m so late,” he said, extending his hand. “I was in surgery.”
I saw that he was in green surgical scrubs. What could I say? I shook hands. “No problem,” I lied. Dr. Hardcastle was, I’d say, in his fifties. He looked more like a farmer or a woodsman than a surgeon, with a shock of white hair and a ruddy complexion. He glanced at the form giving my medical history and asked a few brisk questions. I made sure he knew that neither my father nor my mother had any form of cancer. I also mentioned that I thought my nighttime visits to the bathroom weren’t too bad; I could live with them.
“All right,” he said. “Let’s take a look.” He led me to another room, where, having taken off my pants, I lay down on a table like a victim ready for the sacrifice. I won’t go into the details of my ordeal. Suffice it to say that it involved a vulnerable part of my body and that when it was over I would always think of this room as “The Torture Chamber.” It also revealed that I had scarring of the bladder, not a good thing. Dr. Hardcastle told me this resulted from the bladder to having to work so hard because of blockage from my prostate.
Back in the original room and once again fully clothed, I listened to the doctor’s conclusions. My prostate was enlarged and I needed surgery. The procedure was called a transurethral resection of the prostate, TURP for short; more inelegantly, it was known as a rotor rooter. I asked Dr. Hardcastle about watchful waiting, my first choice of treatment. He told me that, No, this was not an option, and pointed out that my bladder was already scarred. What about the medications I’d read about? No, these were ineffective. In fact, the medication I was now taking might be harmful. What? I didn’t want to hear this. In sum, the doctor had no doubts, I needed surgery.
Somehow, I knew I’d have the surgery, but I said I’d like to see my regular doctor (I wanted to know about those possibly harmful pills anyway) and think about it. I hadn’t had any surgery or even been in a hospital since I had my tonsils taken out as a kid. In even a standard procedure, who knew, something might slip or go wrong. I didn’t want to rush into it. Dr. Hardcastle shrugged, stood up, and said I should make up my mind soon He was a no-nonsense guy.
I left the room and started down the hall, then I remembered, what about prostate cancer? I spun around and ran back. Dr. Hardcastle was still in the room, jotting something down on a form, probably that the patient he’d just seen was a wimp. I asked him about prostate cancer. He looked at me as if I’d posed an especially inane question. “No,” he said. “Of course not.”
The next thing I recall was being back in my car. It was hot. I rolled up the window and turned on the air conditioner. I was going to have surgery, a depressing thought, but at the moment I couldn’t feel depressed. The tightness in my chest that had been there ever since the visit to my HMO doctor was gone. I could breathe freely again. I couldn’t wait to get back and tell my wife the good news.