You know, I’ve never been brave. I’ve been careless or reckless but never brave. That’s just a nice way of saying that I am a coward. When I try to conjure up some remembrance of courage, I’m drawn to missed opportunities, past failings.
I remember arriving at a high school football game to find that a drunk jerk had punched my little brother in the face after he’d made a smartass comment. I walked up to the guy and talked to him while other high schoolers circled in, waiting for the fight. There was no fight since I walked to the bathroom, splashed my face with water, and watched myself shake with impotent rage. I spent the rest of the night getting the guy to apologize to my brother, but it was a half-assed, sloppy apology. You might say that I chose reconciliation rather than conflict – don’t feed me the shit. I should’ve punched the guy in the face on first sight.
Less than six months ago, my girlfriend and I were walking to the L train station. Three guys were loitering along the way. One of them said something to the effect of “I like your hair, baby” (she has dreadlocks). They called out after us “do you use shampoo?” Not once did I say anything or even give one of the guys a hard stare. I just clenched my jaw and looked down; I didn’t even hold her hand or put an arm around her waist. I am a coward.
Even before I lost my right nut, I was worried or scared about whatever little idea happened to be on my mind for that day. It gets tiring. I do nothing and hope for change. It’s the path of least resistance with a healthy helping of self-loathing.
I have three options for future treatment now that the tumor has been removed: “light” chemotherapy, surveillance, or a major surgery. The first option isn’t really an option, since there’s about a 1 in 3 chance that the cancer has spread. Chemotherapy at this point would likely be overkill, and it’s not guaranteed that such a light dose will stop any potential spread. Thus, I’m left deciding between surveillance and surgery.
Surveillance basically means less invasive but less certain follow-ups with more long term risks. The follow-ups would consist of CT scans and blood work every 3 months for the next 5 years. CT scans involve considerably more radiation than regular X-rays, and the exposure risks in the long term are relatively unknown. The doctors would be looking for any enlargement of my abdominal lymph nodes, since they constitute the primary staging site if and when the cancer metastasizes. The internal imaging is detailed but not to the microscopic level. If lymph node enlargement is detected using this method, then there is a definite spread. Surgery is a possibility but chemotherapy is basically a given at that point. If there is any spread, then it will likely take place within the next 2 years.
That’s 2 years of waiting and hoping and basically doing nothing. This decision feels familiar – it’s been my M.O. until now.
Let me describe the other option, the surgery. Have you seen the torture scene near the end of Braveheart? It’s that plus anesthetic and minus the pain and getting my head chopped off at the end. OK, maybe the not best example, so I’ll try fellow one-baller, Tom Green. He received the surgery and you can see it here http://www.youtube.com/watch?v=Th1e5CYY39k (start around 5:30 if you want to skip some of the hilarity).
The surgery is called Retroperitoneal Lymph Node Dissection (RPLND) and starts with an incision just below the sternum. The surgeons continue that cut around and past the belly button. They will spread apart that opening and shift internal organs and intestines out of the way to get to the abdominal lymph nodes. This is where the dissection part of RPLND comes in. The surgeons will remove the lymph nodes that were attached to the infected testicle. Infection, minor bowel obstruction, and retrograde ejaculation are among the possible complications of RPLND.
Retrograde ejaculation means that semen will no longer shoot normally from the penis; instead, ejaculate will terminate into the bladder. This side effect would come from nerve damage; a surgeon may accidentally nick or even sever one of the many nerves during the dissection. Oh yeah, and the recovery time for this operation is 4-6 weeks. I don’t want this fucking surgery.
These three options were presented to me by an Oncologist on Monday morning. I also learned that chemotherapy, which was presented as the last stage of possible treatment, can cause infertility. Although the Oncologist recommended RPLND, I was convinced that I’d choose the surveillance option. My last surgery wasn’t an option, and I’d felt rushed; I’d lost my right testicle within 8 hours of being told that it had a tumor.
I made a decision tree with risks, benefits, and possible outcomes. If I chose surveillance, then I’d just have to wait. Sure, the many CT scans would be a pain in the ass, and the long term cancer risks for that type of radiation exposure aren’t definitely known. But I wouldn’t have to be dissected, and I could go on as usual. If they detected a spread, then other treatments would become necessities rather than options. It would be decided for me. I could wait and see.
Unfortunately, the decision tree also revealed that a RPLND at this early stage had a high probability of halting any spread. If microscopic spread of the cancer was in the lymph nodes, then I’d be essentially cured upon their removal. The tricky part is I’d have to get the surgery within the next month or so to reap the full benefits. I tried to convince myself that surveillance would be the braver option, since I could embrace the uncertainty, let go, and wait.
I went to sleep and hoped that I’d have a vivid dream that would decide for me. That didn’t happen, but my first conscious thought upon waking was Go to Surgery. At this point, I was considering flipping a coin, but my ex-girlfriend has informed me that grown ass men don’t flip coins. They make their own decisions.
Tuesday evening - I’m looking at a random section of the newspaper and reading about a Tennessee leader of a professional women’s organization; she is trying to teach people that Islam isn’t rooted in terrorism and hate. I flip the page to follow the story and see an article about trying to reduce the number of CT scans given to young children because of radiation exposure.
I lock myself in the bathroom, drop my pants, and study myself in the mirror. Half of my pubic hair is still very long, since the surgeons only needed to shave the right half for the previous surgery. I find a pair of scissors and trim the remaining half as best I can. I kind of like the way my cock rests on my remaining ball, which falls more in the middle. In the last week I’ve started thinking of this new arrangement as an interesting oddity, like the pair of webbed toes that I have on each foot. The current arrangement isn’t the problem.
I keep tracing my index finger from my sternum to past my belly button, harder and harder until it leaves a path of red skin. I always thought that having a long scar would be neat, story –worthy. Now, I’m not so sure. I turn on the shower to cover up my sobbing. I’m scared. I can’t do it. I can’t make decisions. I can only wait.
If you are about to be born and plan on having a semi-serious medical condition at a relatively young age, then I recommend that you decide to be born to a Doctor. It’s irresponsible otherwise. The RPLND isn’t a common surgery performed at every hospital. But my parents were in full support mode, and my Dad had two of his colleagues call over to Nashville to get me a consultation with a RPLND-qualified surgeon on Wednesday morning. This worked out perfectly since my flight to Chicago was in Nashville for Wednesday evening.
Before we get to the RPLND consultation, let me assure you that I wasn’t writing out decision trees in a vacuum. I asked for advice. Most of my good friends said it was a tough decision. My ex-girlfriend said she’d take the surveillance option. My Dad suggested exploring the possibilities of laparoscopic surgery, which would involve several, precise incisions rather than peeling me apart. However, skilled laparoscopic surgeons aren’t as familiar with lymph node dissection, and the results are less conclusive. When I asked my Mom what she would do if she were in my position (and had testicles), she said that she’d ask her Mom… what I’m trying to say is every conversation reminded me that, ultimately, the decision had to be mine.
OK – Nashville – we’re seated in the patient room. My Dad is on my left, and my Mom is on my right. The Urological surgeon enters, and he’s a clean-cut Asian guy in his mid-30s. I keep staring at his hands throughout the Q & A session; they look strong and small, perfect for probing my insides. Most of the information I’ve already heard. I find out that if any traces of cancer are found after the RPLND, then I’ll have to undergo two cycles of chemotherapy. I also find out that this relatively light chemo won’t necessarily render me unfertile.
From losing my right testicle to now, I’ve realized that I really want to have kids at some point in my life. I want to teach them to cherish their sense of humor and to make their own decisions. I want to teach them to be strong.
We ask all the possible questions and get all the possible answers for the moment. It’s time to speak. There’s tightness in my chest. I can’t wait any longer. I tell the Urologist that I want to schedule the surgery. He and my parents assure me that there’s at least a few more weeks for me to make my decision. Two days were enough. I tell them I want the surgery.
I’m sick of waiting and doing nothing. I’m goddamned tired of being a coward. The surgery is scheduled for February 8th. Wish me luck.
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