Tuesday, November 8, 2011

My Path

Do not forget to entertain strangers, for by so doing some people have entertained angels without knowing it.   Hebrews 13:2

I admire people who are fighting for their lives. In some respects, I was not necessarily among their ranks at any time. There was always a very good chance that my situation would improve. For some, that hope cannot be found. As far as physical battles go, however, I have never fought harder than these past few days.
It all began in 1994 and as far as I can tell, it may have began sooner. I was complaining of some unusual pain. I would develop chills followed by a low grade fever that would last for a day or so. Wanda Sparks was an RN and a good friend of mine. Wanda’s father-in-law had recently passed away with prostate cancer. I mentioned the symptoms to her and with the combination of her profession and her personal experience, she insisted that I see one of her doctor friends, a specialist in urology. That year, I was diagnosed with a fairly common condition present in older men. But I was only 30. Still, I was going to be dealing with BPH for years to come.
Very few men have prostate enlargement under the age of forty, but 90% of men over the age of 80 are dealing with it today.
Over the next few years, the treatments led my doctors to test for even less likely causes for the recurring problems. It was obviously chronic by definition and I had the symptoms of prostatitis. I got my first PSA at 40 and my doctor explained that the elevated number was likely caused by the recurring infection. But with all the treatments, the numbers would not remain at a safe level. We managed to bring them down for short periods of time, but the side effects from months of antibiotics were beginning to trump the side effects of the actual problem.
I was determined to get more opinions. I went to several specialists until I found Dr. Kenneth Rutledge in 2006. He understood my frustration better than any doctor had before. He has a let’s-get-to-the-bottom-of-this attitude. He wrote a book on my situation and we discussed the effects of the various treatments. He seemed to be as dissatisfied with all of the results as I was.
In July of 2010, Dr. Rutledge shocked me by recommending a biopsy. “What will that do?” I asked.
“It will rule out cancer.” He said.
“Mark,” he said, “Don’t worry. I don’t think you have cancer. It’s very unlikely and you are otherwise young and healthy, but your situation has not been following any normal pattern and we need to get as much information as possible.”
I thought about it. I prayed about it. I reasoned that it would indeed be unlikely. There hasn’t been a sign of prostate cancer in my family. But I watched my doctors as they read my charts. Dr. Rutledge would just sit there with me in silence while he would read over the results again and again. “Let’s get to the bottom of this.” He said.
I had the biopsy and went in for the follow-up to discuss the results. Jennifer was determined to be there. I told her to go to work and I would call her in a little while. I was almost sure that we’d continue trying one antibiotic after another until I was 80 and, just like my peers, dealing with a condition older men deal with. They’d never have to know I had been dealing with it since I was 30. Jennifer wouldn’t hear it. As with every visit over the 2 ½ year history of our relationship, she was there.
The nurse sort of gave it away. I could see it in her caring eyes. When she opened the door and said, “Mr. Coker.” She looked at Jennifer as if they knew each other well and said, “You come too.”
That was when the reality began moving through me like a sedative. Instead of freaking out like I always thought I would, there was some sort of calm. It was unreasonable to feel so calm. I can’t tell you where that came from, but being a man of faith, I think God must have programmed us to deal with life in times like this.
We sat down in Dr. Rutledge’s office and he didn’t keep us waiting. He came in and smiled as always, but this time, I could tell he was making a little effort to do so. The first thing I noticed was a shiny new book in his hand. He sort of put it out of sight as he walked in and I didn’t catch the title.
“Mark,” He said, “You know I would love to give you and Jennifer some good news but today, the news isn’t all good. It’s the best bad news I can give you, but the biopsy did reveal the tiniest trace of cancer. Out of ten areas, we found nine of them to be benign. Where we did find a trace, it is thankfully still Gleason 6.”
The Gleason Score was named after pathologist Donald Gleason. Of course I can’t completely understand the scoring system, but Dr. Rutledge put it this way:
“Typically, we don’t see the cancer spreading until the Gleason reaches 7. It is not impossible, but less likely. And since your situation has always been a little unusual, I want to rule out that possibility as well. I will say this: the symptoms you’ve always had have nothing to do with this small trace of cancer. The other problems are in no way related. Thankfully, those symptoms led us to this biopsy and we’ve found this problem early and almost by accident.”
It wasn’t by accident. The most unusual thing happened after the biopsy: my PSA began dropping well into the normal range and my symptoms began to subside. I was feeling great and I didn’t even need antibiotics anymore.
I am not sure why I would need to get this early warning in such a round-about way, but once I had been properly alerted, the warnings all but stopped. Now Dr. Rutledge was reading my charts and saying things like, “This is odd, your prostate is shrinking and your PSA is getting better.”
He recommended watchful waiting. I was good with it in a way. Jennifer didn’t like it at all. This idea is based on the theory that we should be able to detect the jump from Gleason 6 to Gleason 7 in time to react. Prostate cancer is a slow growing cancer and this idea is new, but not entirely crazy. Clark Howard has been watching and waiting since 2007. But even Clarke Howard says, “75% of people diagnosed with prostate cancer need treatment of some form within weeks or months.”
I watched for a year and continued to get better PSA scores. My symptoms were just about all gone and I was feeling better than ever when it was time for my second annual biopsy this year. Jennifer had been doing some research and she wanted me to try Dr. Wong. “He has experience with every option.” She said.
I wanted to hear about the latest technology. I wanted someone to explain all of the new treatments. Dr. Wong, for instance, was the first urologist in North America to perform the Nanoknife procedure for prostate cancer.
The second biopsy revealed three areas of concern and those areas were not together. Dr. Wong carefully explained that I was still likely to survive and the scores were still Gleason 6. When I asked him about the danger in waiting at this point he said, “It could move from a 6 to a 7 within a year and there is a small chance that it could even metastasize.”
I knew what that meant and waiting was not going to be an option anymore. I had to prepare for treatment. Older men often take the “seeds” route and that’s a very effective treatment. In those cases, the men are sometimes right back at work and living a normal life with no more worries. Dr. Wong said something I haven’t heard since I tried to buy beer when I was 18: “You are too young.”
The treatment options – all of them – have side effects of their own. One of the side effects from the seeds could be delayed 20 or 30 years. In some cases, they are very mild even then. Dr. Wong explained that he wanted to look at my overall health and predict how long I should otherwise live. He said that he could see me making it into my 90’s. “The problem with any kind of radiation,” He explained, “Is the fact that it may begin to give you some problems in 20, 30 or even 40 years. If you were 70, we probably wouldn’t want to do anything. If you were 60, we might try the seeds. But you are 47 and you have had problems with your prostate that aren’t connected with this problem. Unfortunately, those problems could get worse when we introduce the seeds and then, we could not operate.”
The other options are extremely promising but Dr. Wong thought I was too young for those treatments as well. Some of them are so new that the research only goes back two years. If I was 80, and surgery was necessary, I would try the Nanoknife; we know it works for a few years but there is no research older than that.
I went home with the new information and eventually made the decision to have the procedure in November. This fast-forwards the story to the second of November, 6 days ago. I worked all day on Tuesday and never felt better in my life. I knew that this would not be the case within 24 hours. After work, I went home and began to prepare for the next day or so at Piedmont. I went to bed early and Jennifer came and woke me up around 4:30 AM. We were at the hospital a little after 6:30 AM.
I was nervous. Although I had been mentally preparing myself for this day, I was still not quite ready. I met briefly with Dr. Wong and other doctors and I was rolled back to the operating room. They must have given me something to calm me at this point. I can only remember bits and pieces of the next few minutes. The next thing I remember is a recovery nurse standing over me telling me that it was over.
It must have been around 1:30 PM when Jennifer told everyone that they should head to my room. My mom said, “Jennifer just stood up and said, ‘I am not waiting anymore. I am sure he is there by now.’ And she was right. Even though nobody called us, they had just brought you up when we got there.”
I started waking up a little at a time. When they told me what time it was, I remember wondering what had taken so long. I started demanding answers. I was afraid there had been complications. “Jennifer, you would tell me. What did the Dr. say?”
Then I would pose the same question to my mom and my brother, Bill. They all told me that it had gone well, but I still worried for a while. Dr. Wong came in and I asked him how it went. “Perfect.” He said.
Myra was there. Jackie was there. My pastor had been there too.
I was in some pain but it was being monitored and managed by a great staff at Piedmont. The pain and the management thereof kept in the hospital until Saturday morning.
Jennifer was there every time my eyes opened. She slept on a hard piece of furniture with a crude cushion. If I had pain every hour, every hour, she was there telling me to squeeze her hand. If I got up, she lifted me. She helped the nurses and did more than all of them put together. There were some of those humiliating moments and Jennifer just ignored them and smiled as if to say we’d joke about this later.
The nurses were all great. Dr. Wong would come in and sit by my bed and talk to me like an old friend.
I was still in the hospital when the pathology report came in on Friday. Dr. Wong didn’t call; he came straight to my room and said, “Good news Mark. Something will take your life one day, but according to your pristine pathology report, it won’t be prostate cancer.”
One of our favorite nurses, Joel, had already seen the report and even alluded to it. He was in my room for his routine pep talk and he said, “I’ve seen your path and you are going to live a long time.”
At that time, I didn’t know that path was short for pathology report. I thought he was talking about the path of my life. Joel and I had become friends in a hurry and I figured he was assuming that I was a good guy. He was still in there when Dr. Wong broke the news and he put his hand over his mouth and said, “I nearly gave it away.”
But I will take it either way. There are no mistakes. I’d like to think of Joel as a messenger. There is a path. I’ve been on this one a while. Wanda was there. Dr. Rutledge was there. My family has been there. Jennifer is there. My friends have been there. Aren’t we supposed to believe in angels? Couldn’t Joel be one?
The next day, Joel came to say goodbye. He said, “I don’t normally work on this floor. I’m back upstairs today. I just wanted to say goodbye.”
As another angel once said, “Strange isn’t it? Each man’s life touches so many other lives.” Clarence Oddbody, It’s A Wonderful Life.