Posts Tagged 'biopsy'

A Look Inside

My annual physical is usually uneventful. A little high blood pressure partnered with an aging prostate have been my only close, chronic companions for many years. But this year a new friend came calling.

If you’re old enough, you’ve probably done that little test that involves the toilet, a flip card with three distinct slots and some wooden sticks like the ones that remain after you down a cherry popsicle. It’s a routine exercise that looks for suspicious characters who can wreak havoc in your colon.

A call from Barbara in Dr. Halverson’s office began the adventure. “Hello Fred, it’s Barbara. We found some microscopic blood in your stool and Dr. Halverson wants you to have a colonoscopy.” Barbara makes the calls that you’d rather not receive. She does it so well that at first you think she’s inviting you to a birthday party. And then it dawns on you. This is no party. This is serious business. Oh crap, I said without thinking of the possible pun. Images and scary thoughts floated through my head at lightning speed. All were X-Rated.

I called Dr. Covington’s office. The doctor and my colon have been close friends for about twenty years. He’s peered inside of it twice during routine colonoscopies without discovering anything of concern. But this was different. You need a preliminary office visit after which we can schedule the procedure. The impersonal voice on the phone wasn’t concerned about my colon and booked me for a visit two weeks hence. I thought Two weeks. Too much time to think. Too many scenarios to ponder.

But, like time will do, two weeks passed and I presented myself to Natasha, Dr. Covington’s physician assistant who took my blood pressure and scrolled through my medical history. “Yes, you should have a colonoscopy”, Natasha announced. It was comforting to know that the medical establishment was of a common mind. The procedure was etched into Dr. Covington’s schedule and I continued to consider possible outcomes, the most probable of which would not be found in a Dr. Seuss book.

The night before the procedure is laughingly called prep time. The Medicine Shop had kindly provided all of the essentials. Two six-ounce bottles of ghastly liquid, a sixteen-ounce plastic mixing container and a set of instructions and no-no’s that I dutifully read several times. Some years ago, before cooler heads prevailed, I had the pleasure of downing a silo full of liquid intended to wash out the colon. That grueling experience would have been adopted as an Olympic event had it not been replaced by the more innocuous six-ounce bottles. On this occasion, the current, less onerous procedure proved quite effective.

In the morning, my good friend and neighbor Yoram drove me to the colonoscopy center. The parking lot was full, populated by cars whose owners had empty, squeaky clean colons. The waiting area, behind a fortified door fit for a bank, was packed with apprehensive patients and their keepers.

Looking at the rows of glum faces, I spotted my friend Alan and his wife, Margo. “They’re running about a half-hour behind schedule.” Settling in for the long haul, I made idle chit-chat with Margo while Alan waited for his call to duty. His turn came and he walked the green mile through the double doors and into the preparation area.

My turn came about thirty minutes later. Lifting myself from the chair, I followed Nurse Ratched into the prep area where I removed my clothes, dutifully slipped beneath the sheet and waited. My personal assistant, a lovely RN, arrived and poked my arm with a probe seeking the fountain of youth. Or, save that, a working vein. Failing to do that, she then focused on my hand and deftly slipped the needle into the most sensitive part of my arm and announced, like Ponce de Leon, Eureka, I have found it.

My friend Alan, having completed the expedition into his colon, lay next to me. We spoke of the grand and glorious things that had been revealed by his colonoscopy, the current state of politics in this country, and the benefits of old age…which did not take very long.

We were one hour behind schedule when I was wheeled into a room that looked like it needed redecorating. Two lovely assistants made sure I knew who I was and told me that this would be over quickly. They donned outfits complete with face masks that reminded me of the costumes worn by the nuclear reactor bad guys in the James Bond movie Doctor No. I felt a little apprehensive, as all I had on was a K-Mart bed sheet.

Dr. Covington appeared and introduced himself for the third time in twenty years. I excused his lapse of memory for faces, since he normally focuses on the opposite end of his guest’s body. He said “Here come the meds.” And the next thing I knew I was standing by my gurney putting on my shoes.

It was all over but the shouting. Friend Yoram relayed the news from Dr. Covington. No bleeding, one small polyp removed. Nothing to worry about…except the seven days’ wait for the biopsy results. I sent some text messages. All is well and the usual stuff you add to relieve the stress. We had a hazy lunch at a restaurant that I will never be able to find again.

That evening I went to bed early. Awaking around 3am, I tried to reconstruct the last fifteen hours. I vaguely recalled Yoram’s prognosis but I questioned the accuracy of my memory. Had I really heard the findings as I now recalled them or was I hallucinating? I remembered the text messages and got out of bed to check my phone. There they were…including one that reminded me of the seven days of waiting for the biopsy results. Like opening an old scab.

Is life at my age a series of medical events, each one with the potential to seriously alter hopes and dreams? Does one live life fullest between annual physicals? Does time pass too quickly, with a cloud hovering over us like Al Capps’ Joe Btfsplk?

Seven days passed and I was able to push the biopsy to the furthermost corner of my mind. Not completely forgotten, but not preeminent.

Tuesday the phone rang and I missed the call. A message had been left by an 805 number I did not recognize. I listened to the call.  Hello, this is Doctor Covington’s office… Time stopped and I reviewed the possible second sentence scenarios at warp speed. I thought the rest of the message would never find its way to my ear. But it did. The polyp was benign. See you in five years.

The clouds lifted. It was time for a song. One that celebrates life and makes us live it while we can.

The results are in…

Where were we?  Oh yes, we had just completed my prostate biopsy.

Now it was time to await the results.  Dr. Greenberg had said “Should take about a week to get it back from the lab.  I don’t like to phone results to my patients.  So make an appointment and you can come in to see how things turned out.  Good or bad.”  Fair enough.  After all, how long could a week of waiting be?

I strolled confidently to the cute young lady at the front desk.  The one who makes calls to patients’ answering machines and rattles off information faster than any human can write it down.  “Hi” I said confidently.  “How about an appointment next Tuesday?  The Doctor says my results should be here by then.”  Silence.  Followed by her nimble fingers doing speed of light calisthenics on the computer keyboard.  Followed by more silence.  “Hmmmm.  Looks like we’re booked.  The earliest I can get you in is next Friday morning.  How’s 8:40?”  Restraining myself from leaping over the counter, strangling the young lady with her telephone cord, and making my own appointment, I sheepishly said “OK.”

Ten days to wait for results.  Ten days to try not thinking about it.  Ten days to imagine the worst.  Anything from “Hey, no problem, you’re OK.  Go home.”  To “It’s stage four.  Get into Hospice and put your affairs in order…today.”

The days passed and I was, at first, only mildly irritated.  Young children I encountered on the street sensed that I should be avoided.  My feeling of foreboding grew to tsunami proportions and it took all of Sweetie’s cooing and cajoling to keep me from self-immolation.  I pasted a perpetual smile on my face and studiously maintained my public persona so as to avoid losing all of my friends.

Sleeping was fraught with adventure.  Getting to sleep was no problem.  Staying asleep was.  I tried various mind tricks.  First I imagined lush green fields with bubbling brooks.  No good.  So I enhanced my vision of lush green fields by adding romping, nubile maidens.  Not good enough.  So I simply deleted the green fields and focused completely on the nubile maidens.  Nothing was a panacea.

Instead of sticking with the Marx Brothers, Woody Allen and the U.S. Congress for laughs, I made the mistake of reading The Worst Hard Time by Timothy Egan.  A long repetitive dissertation on the Dust Bowl of the 1930’s, it reveled in a glorious depiction of the misery of those poor farmers who lost their land to the wind, and were forced to rely on clubbing rabbits to death and boiling tumbleweed for sustenance.  As an added bonus, the book described the concurrent, abject misery of the Great Depression and the twenty-five percent of out-of-work, apple selling Americans.  On the other hand, maybe reading about their misery deflected a bit from my own self-imposed malaise.

Thursday night was mostly sleepless as the nubile maidens all sought refuge from me.  Arising well before we needed to, we leapt from bed, did our best to greet the rather dark morning, and got in the car for the forty minute trip to Ventura.  Needless to say, we arrived at the place of execution a full thirty minutes early.

The waiting room was empty except for the young lady with the flying fingers.  She was removing the last vestiges of Halloween decorations including the monstrous hanging ghost that happily greeted us on our arrival.  I decided to read Wine Spectator in the foolish hope that I might get seriously drunk.

A rather large man and his rather large wife entered the waiting room.  He held a large manila envelope that obviously contained a very large x-ray.  The Rather Larges sat across from us.  Mr. Rather Large stared straight ahead for a full twenty minutes and held onto the envelope in the same way that Charlton Heston  famously rabble-roused the NRA with his cold, dead hands speech.  I realized that I was not alone in my misery.

“Mr. Rothenberg, you can come in now.” Nurse Ratched said as she opened the door to the business end of Doctor Goldberg’s shop of horrors.

We sat in the exam room.  My blood pressure reading taken by Nurse Ratched was at the high-end of abnormal and my throbbing pulse could be felt without the need of placing her fingers on my wrist.  “How have you been feeling since the biopsy?” she said.  “Fine” I lied.

Waiting for the Doctor to make an entry, Sweetie and I talked about things of which I have no recollection.  For some strange reason, my mind wandered back to 1960.  I remembered anxiously awaiting the results of my CPA exam, results that would appear in my mailbox.  I remembered what my fellow exam takers had said.  “If your results come in a big fat envelope, you failed the exam.  The fat envelope has all kinds of stuff including how to reapply and retake that awful test.  If you get a nice thin letter, it will simply have your passing grades.”  I thought, “I hope Dr. Greenberg has a nice thin piece of paper.”

He did.  And we went home.

Slide your fanny a little…

“Slide your fanny a little bit back from the edge.  A little more.  Until it touches my hand.  That’s it.  You got it.”

Risque?  Hardly.  Warm and fuzzy?  No.  It was only Nurse Ratched getting me in position for my long anticipated prostate biopsy.  Sexual innuendos and any semblance of privacy were the farthest things from my mind.

For those of you who have faithfully followed my blog, you may recall a piece I wrote about a year ago that displayed in living color the unrelenting progress of my PSA readings.  Readings that, in some corners of the medical establishment, leave the suspicion of a sinister, cancerous infestation of my prostate gland.

I had dutifully made several breath-holding follow-up visits to Dr. Goldberg my busy, generally humorless, urologist.  This series of perilous events  led to the last one, an all too brief encounter a month ago where he blandly announced “Your PSA is up again.  Time to find out what’s really going on in there.  It’s fifty-fifty on the outcome.”   Huh? I thought.  That’s it?  No preliminaries, no show-and-tell.  Not even a hand on the shoulder.  “Just make a biopsy appointment for a couple of weeks from now and bring your body back here.”

During those weeks I had ample opportunity to think about the worst and to explore in-depth the components of the dreaded procedure.  However, except for a couple of brief light-hearted discussions with friends, I disdained the bountiful educational opportunities offered by the web, the local library and the Jewish Forward.  The most memorable and illuminating conversation was the one had with Harry.  “I spoke to a friend of mine.  He had a prostate biopsy.  No big deal.”  My, how reassuring.

The big day arrived.  I prepared and cleansed my body as instructed.  I swallowed the rather large antibiotic pill taken as a precaution against a possible infection that I was convinced was surely as deadly as 18th century bubonic plague.

Sweetie and I arrived at Dr. Goldberg’s office, early as usual.  I embarked on the obligatory viewing of the same travel magazines seen during my earlier visits and, realizing that I had absolutely no idea of what I was reading, settled back while the clock wound past my appointed time.

Other than the need to argue with the bookkeeper about co-pays, I passed the time wondering what particular urinary malady was afflicting each of the other sullen faced men sharing the waiting room with me.  The Halloween decorations, especially the sheeted ghost hanging by its neck over the entry door, did little to lift one’s spirits.

Nurse Ratched appeared and escorted me to the operating chamber.  I was a bit disappointed, given the singular importance of the upcoming procedure, that it did not look more like Mel Brooks’ laboratory in Young Frankenstein.  Nurse Ratched took my blood pressure, pulse and temperature.  All were functioning…a good sign I thought.  I was then instructed in the proper removal of clothing and the donning of that never to stay in place paper cover-up.  I was left sitting backless and alone on the dissection table.  “Back in a few seconds” Nurse Ratched promised.

Time passed.  Anticipating that I might somehow be forgotten and left to starve to death, I reviewed the contents of the chamber.  The most imposing element was an ultrasound machine.  This clever device is used by the physician to locate, measure and help zero in on the parts of the prostate gland that have been chosen by lottery as the lucky ones for biopsy.

Once located, a small snippet of obviously useless living matter is clipped, removed from the dark recesses of one’s body and deposited in a carefully (I hoped) marked container to be sent off to that mysterious place that none of us has ever visited, called the lab. There it sits ignored for what seems like an eternity while god only knows what is done to it to determine whether it is, in that generic inoffensive terminology, negative or positive.

The scariest piece of the ultrasound machine is the probe that will, when the smiling doctor appears, be shoved ingloriously into your anus on its way to the blessed area occupied by that one ounce piece of meat called your prostate gland.  With time on my hands, I had ample opportunity to observe the impossible size of the probe and I wondered what it might be like to be incarcerated in prison with giant men who have been deprived of female company.  Not a pretty sight.

And for more laughs, I stared at the near life-sized chart on the wall depicting a fully functioning urinary system including a monstrous penis that put me to shame.

Having waited for what seemed like hours, I was preparing to remove my useless paper cover-up, get dressed and sneak from the office when Dr. Goldberg arrived.   Nurse Ratched, careful to make no clever comments about my private parts, began the arduous job of sliding and positioning my fanny.  She then  placed my feet into the same kind of stirrups that you women are more likely to encounter as you pass through life.  I really don’t know how you manage it.

“We’re going to take ten snippets” Dr. Goldberg announced.  “The hardest part is getting this probe past your great wall of China.  After that it’s a walk in the park.”

Around snip number three, and concerned that I might be left prostate free, I asked how much the ten snippets weighed.  “Everyone asks that” Dr. Goldberg laughingly said.  “Your prostate weighs about twenty-eight grams and the snippets will total less than a gram.”  Seemed hardly worth the effort, I thought.

Snippet ten occurred at about the five-minute mark.  Or, in Fred time, about twelve hours.  Done, we all breathed a well-earned sigh of relief.  I was allowed to recover some of my dignity, get dressed and proceed to the waiting room of sullen men where I gave Sweetie a big kiss.  I’m due back in Dr. Goldberg’s office in about a week.

Meanwhile Harry, tell your friend that he must have practiced.

Adventures in Medicine…Part 2

It started innocently enough.  Time for Sweetie’s annual mammogram.  For the uninitiated, a mammogram involves having your breasts compressed by a mid-Victorian machine that, according to Sweetie, was designed by men who never had the pleasure of the experience.

For more years than I care to count Sweetie has been subjected to mammograms, some of which have been followed by needle biopsies, breast sampling and related invasive procedures.  Luckily, none have discovered evidence of the big “C”.  In fact, it’s been many years since a breast exploration required anything more than the squishing by the mammo machine, followed by Dr. Jim’s all-clear pronouncement.

Off we went to Ojai Community Hospital.  A calm and unhurried place it is.  Coffee is provided to those of us who must sit and wait while our loved ones are prepared, poked and prodded.   Java and Joe’s has nothing to worry about but a cup of hot liquid helps to pass the time while one reads every word of the free, frequently inane Ojai and Ventura View…twice.

Ah, there she is, finished being squished.  “Piece of cake…let’s get some breakfast at Eggs and Things.” she says.  No sweat.  Routine.

Two days later the phone rings.  Nurse Barbara asks for Sweetie.  “Hi, uh, they found something unusual on the mammogram.  They want you to have an ultrasound.  No big deal.  Better to make sure.  I’ll ask the hospital to call and set one up.”  And they do.  For a week later.  No sense rushing things.  Let’s not get excited.  But we do.

We arrive.  “Hi, I’m Ralph.  I’ll be doing your ultrasound.  Right breast, correct?”  No need for a female attendant.  I’ve elected to sit and watch while Ralph explores my wife’s private parts.  I view the monitor as the hills, valleys and undersea gardens appear on the screen.  I think every ripple bodes ill.  I scan Ralph’s face for clues.  None.  He’s good.

“All done.  But before you get dressed, let me get the radiologist to take a peek at things.”  Dr. Bob enters the semi-darkened exam room.  He peers at the snapshots that Ralph took.  I watch his face for clues.  None.  He’s good. 

“Uh, you see this shadowy area.  Right here, above your nipple.  I can’t be sure what’s there.  Probably nothing.  But I think we should do a needle biopsy.  Hopefully, it’ll be OK.”  Sure it will.  Let’s not get excited.  But we do.

Coincidentally, Sweetie’s annual physical with Dr. Jim is scheduled two days later.  We arrive.  Dr. Jim is concerned but calm.  “You know, with your family history, we really should do the biopsy.  Better to be sure.”  I suppose I’d hoped he’d say “Forget about the biopsy.  What does that guy know anyway?  You look the picture of health.  Go home.  See you in a year.”  We schedule the biopsy for a week later.  Let’s not get excited.  But we do.

Jan the hospital nurse greets us, escorts us to the outpatient area and prepares Sweetie for the biopsy.  “You’re lucky.  Dr. Julia is doing the procedure.  She’s done it a million times.  I’d pick her to do mine.”  Ah, I think.  We’ve got the breast queen.  Lucky us.

I’m shooed out to the lobby.  “Wait here.  I’ll come get you when it’s all over.”  Sure she will.  I picture myself dehydrated and covered with cobwebs.  “He waited too long”, they will say.  I read the same Ojai and Ventura View without understanding a word.

She comes and gets me.  So far so good.  “It’ll be about five to seven days before pathology has any results.”  I calculate.  It’s Monday morning.  Five days takes us to Friday.  If we don’t hear by Friday, the Memorial Day weekend starts.  That takes us to Tuesday, next week.  Crap.  Let’s not worry.  But we do.

The week passes, very slowly, as in a fog.  By Wednesday, I react every time the phone rings.  When we are away I constantly check for messages.  I try to hide my anxiety from Sweetie.  She’s doing a lot better than me, a whole lot.  I marvel at her composure.  But I know what’s going on inside.

Thoughts race through my head.  What if?  I’m nicer than usual.  I don’t need to be asked twice. I pick up after myself.  I don’t leave the paper on the table.  “Whatever you want.  Sure, that’s great.  You’re absolutely right.  What can I do for you.  Here, let me do that.  You look terrific.  I love you.”

Friday morning. “Uh, maybe you should call Nurse Barbara in Dr. Jim’s office.  Who knows, maybe they got the results.”  Sweetie, hesitates.  Then dials.  She’s caught in a telephone loop.  She hangs up.  Crap.

It’s mid-afternoon.  “Uh, maybe you should try Nurse Barbara again.”  Contact is made with Dr. Jim’s receptionist. “Hi, I had a breast biopsy on Monday and I wonder if you got the results yet.”  I sense the woman on the other end of the line picturing herself in Sweetie’s skin.

In a nanosecond, Nurse Barbara is on the line.  “Hi Ila, I’d be a little surprised if the results were in yet, but let me get your file.”  An eternity passes.  “Well, here it is.”  I watch Sweetie’s face while she listens to Barbara reading the results.  Her mouth slowly molds into a broad smile.  She gives me the thumbs up.  “Thank you Barbara. Have a wonderful weekend.”

Her eyes moisten, so do mine.


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