The Good Doctor

So my good doctor is retiring. He told me this as he was gazing at the video screen and manipulating a tiny camera in my innards.

“Hmm, well, you’ll see Dr. K next time. Looks good. Yes. I’m leaving. February. Nope, don’t see anything in there. Looking good. That’s what, the third clean exam? Good work. Good work.”

This is the doctor to whom, two years ago after my fifth operation, I wrote a Valentine:

I’m glad that you’re here

I would be much sadder

If you weren’t around

To take care of my bladder!

He never mentioned it, but his nurse said he liked it.

He’s read a couple of my books and even listened to a few songs I wrote.

Now I’m lying on the examination table waiting for his arrival and watching seconds tick away on the wall clock. The good doctor has done this test on me about a dozen times now. It’s never pleasant, and I’m always nervous, so that when he comes into the room and says, “Mr. Sagnier, how are you?” I respond without fail, “Scared,” and he replies, “Hmpf.”

He was, at times, alarmingly actual. “Well, of course, if it spreads, we’ll take out your bladder…”

“WHAT??”

“But probably we won’t have to.”

In January, he examined me shortly after the New Year. He was looking a little sallow, a little pinched around the eyes. He said something to the effect of, “Glad I’m not operating today. A little too much cheer with the neighbors. Hmpf.”

I was glad too.

My good doctor made me feel safe, and even when the news was not good. When yet another operation was scheduled, he radiated a sense of confidence. After surgery, he’d do the post-operative visit and say, “You won’t remember this but…” and explain everything. He was right most of the time. Coming out from under—and happy to do so—I couldn’t recall what he’d told me, so I’d email him the next day to get clarification. Mostly, he’d write back, “Got it all! See you next week!” Then I’d get the full and sometimes scary scoop. “Some invasive stuff, so we’re going to do another course of BCG…”

And we would. I’d be injected with a solution of sheep cells carrying inactivated tuberculosis bacteria which, according to the web’s Chemocare site, “is thought to bring about an immune response in the bladder by triggering an inflammatory reaction.  This reaction brings disease-fighting white blood cells and cytokines to the bladder.  The immune system cells then fight directly against the tumor cells.” I thought the process was rather weird but the good doctor was reassuring. “The treatment was invented in France!” In France? Really? Well, that makes it all okay!

I’ll miss the good doctor, and do hope the next physician will be as personable. This is scary stuff and a good doctor makes all the difference.  

Well Crap

Well crap. The cancer is back. Again. A test done this morning shows several small recurrences, and another surgery—or two—are imminent. What bothers me more, I think, is the fact that the nasty cells seem to have spread.  I was too taken aback to ask the doctor sensible questions and I suppose I should not interpret his worried look as anything more than decent bedside manners. Still, I feel as if I’ve been punched in the gut.

What this implies, regardless of the surgical outcome, is several more months of BCG treatment. Bacillus Calmette-Guerin is the action of choice for post-operative bladder cancer care. As chemotherapies go, it is one of the more benign. There’s no hair loss, though in me the process has led to nausea, vomiting, loss of appetite and fatigue. It is unpleasant, embarrassing and demeaning. Having a catheter used to shoot my bladder full of a bacterial compound, the workings of which is not understood, is unsettling. I’ve read that the process is believed to work by stimulating an immune response, or causing an irritation of the bladder wall that fights cancer cells, but the truth is, no one really knows. The success rate of the treatment is relatively high at 63 percent after 15 years, though some studies indicate the survival rate of only 50 percent after five years.

I am a prime candidate, a white male over 65 with a history of smoking, even though I quit more than 15 years ago.

I’m trying hard to go with the notion that stuff simply happens, rather than be vexed and say stuff happens to me. I am not being entirely successful. Crap.