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  volume 1. issue two  
 
Feature
A collection of poetry
by Patricia Wellingham-Jones

from Mongolian Art Exhibit

I turn a corner, stunned now by faces / on the wall—masks of deities, shamans, / in papier-mâché, carved wood, stuffed skin. / Black brows pull down over glaring eyes, / red mouths stretch in snarls or gentle smiles. (more...)
POETRY
Patricia Wellingham-Jones
Isabelle Ghaneh
Todd Heldt
Pamela Miller
Joan Dy
Lina ramona Vitkauskas
Michelle Bitting
Arthur Joyce
Adrienne Lewis
Anne Durant
Kathryn Ugoretz
Cheryl Stiles
Ellaraine Lockie
Arlene Ang
Ellen Wade Beals
JeFF Stumpo
Lita Sorensen
Andrena Zawinski
Rebecca Clark
Jim Coppoc
Carly Sachs
CREATIVE NONFICTION
Siri Steiner
Theodore Worozbyt
Hal Ackerman
VISUAL ART
Gretchen Skillman
Shawn Sargent
Rebecca Harper
Concetta Ceriello
Patrick Tucker
PRINT EDITION
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How Prostate Cancer Made a Man of Me
by Hal Ackerman

I
“How I Found Out”

I always thought it would be my heart. My father’s conked out on him before he was fifty. My uncle’s and grandfather’s too. I do all the right things to counter my genetics; no red meat or tobacco, an approximation of tennis three times a week, an annual physical. All the paper umbrellas we hold up against the thousand pound safe that’s falling at us from an indeterminate distance.

Dr. Gilbert Norton is the head of Family Health at the University Medical Center where I teach. He makes small talk about our respective students as thumps and listens and probes and prods.

I come this close to escaping without any bad news. I have gotten dressed. We have made the parting pleasantries. I have one foot out the door when he asks as a casual afterthought, “Have we checked your PSA lately?” The question carries with it the burden of responsible upkeep. (When was the last time we checked that transmission fluid, those fan belts?”) I mumble that I think it’s been a year. He says it’s been two and suggests that we ought to do a digital exam.

Lest there be any misunderstanding surrounding the phrase digital examination, it is not an examination of the digits. It is an examination by the digits into an area beyond the digit’s easy reach

“I feel a roughness on one side,” he says. I feel the expression in his voice change. The color of the room changes. My breathing changes. “Was this ever here before?” Why the hell is he asking me? It’s his goddamn job to know. But of course he knows. And of course I know. It was not there before. He tells me not to get too concerned until we see the results of the PSA test. He draws a vial of blood.

At this moment my ignorance of my own body is monumental. I have never heard of the term Prostate Specific Androgen? And for the prostate gland itself? It’s like Bulgaria. No one is quite sure where it is or what goes on there. When calls me the following day there is no small talk about students. My PSA has come back at 11.8. I have no standard to measure that by but I hear no sigh of relief in his voice. I ask him what’s normal for someone my age. I’m ready to hear seven or eight. I brace myself for six. “Around two or three,” he says. “Anything over four we get a little concerned.” Before I can stop myself, I blurt out a sentence that contains the words “I” and “cancer” in closer proximity than I have ever spoken those two words before. He gives me the name of a Urologist who will perform a biopsy.

When I call, his receptionist tells me the doctor is booked up for a month. I tell her that’s fine, I don’t think it’s anything urgent. Before she hangs up she asks what my PSA is. She tells me to hold on, and when she returns moments later, she says the doctor wants to see me the following day. I feel like one of those people who has clout at a trendy restaurant. Except not. Except so very not.

II
“Biopsy”

Doctor Fish’s nurse- receptionist is a woman with tight curled hair and a sheaf of papers on a clipboard. She is not by nature a kind woman, but experience has softened her the way a river changes limestone. “Answer these questions please: Difficulty in starting urination? Dribbling after urination? Discomfort with urination? Dark urine? Blood in urine? Inability to hold urine? Inability to get erection?” I don’t mind the questions. I’ve been in the LA single scene for so long, the interrogation sounds like a first date.

She brings me into the examination room and leaves me to await Doctor Fish. The cubicle is small and sterile and populated with the tools of the urology trade, rubber gloves, KY jelly an examination table. Samples are taken from twelve cores. A needle at the end of a slingshot is shot five centimeters into the gland. Think about jabbing a hot dog on the grill to see if it’s ready.

I spend the next two days not thinking about it at all. If I ignore it, it can’t hurt me. I realize this is my mother’s strategy about bees. Which doesn’t even work on bees.

“You’ve got a good bit of cancer there,” are the words he uses when he brings me the results of the biopsy. “Cancer in nine of the twelve cores. He assures me that if I had to get cancer, this was the best kind to get. His inflection, the philosophical nod of the head, are so well practiced that they seem spontaneously derived for this performance. I wait confidently his nurse to burst into the office brandishing a fax from the testing lab: “Dear Mister Ackerman. Boy are our faces red. We sent the results to the wrong guy. It is he, not you that must face his own mortality. We regret the inconvenience and hope you’ll think of us for all your future cancer-screening needs.

But instead Dr. Fish is discussing the efficacy of surgery and radiation. And as horrific as these options sound they are only available of the cancer is localized in the prostate capsule. If they have spread, its chemo. I am led down to the sub-sub basement for an MRI. I am in a trance of obedience, following signs toward NUCLEAR MEDICINE. I am strapped down into a body tray and cautioned not to move or breathe while a probe is inserted into my rectum and inflated to the size of a squirrel. Autonomous mechanisms whir and groan underneath me and a featureless cocoon slowly covers my body, first to my chest, then to my chin until I am completely enclosed in a shell half an inch from my face.

To avoid claustrophobia I close my eyes and visualize endless galaxies, a universe of stars falling all around me like a snow dome. After twenty minutes the probe is deflated and removed and I am brought next door for the bone scan. I catch fragments of conversation between the technicians as they read the preliminary results. One of them uses the term hot spots. The other says they better take some more pictures.

It is 5:30 in the afternoon on December 8, 1999 when I return to the outside world. The sky has an exceptional fall glow, cobalt blue with streaks of reddish orange clouds, and I have cancer. There is an exciting hint of a bite in the air and I have cancer. People are walking across the long promenade coming in and out of the building. Their kids run before them, erratic and thoughtless. I drive homewardly and try to keep the future inflated in front of me but it keeps collapsing as though I had inhaled a plastic bag. I see mental images of that second group of X-rays dotted with pulsating points of light. Hot spots. Galaxies of disease. I put a Tom Waits song on that has a repeating refrain, “Hold on, hold on, babe you got to hold on.” I hold on.

My daughter has just turned twenty; the age I was when my own father died. The weight of all the things I have not taught her yet falls on my head like a closet full of bowling pins. I plan the music for my funeral.

It is nearly dark when I get home. There’s a current of fresh smelling air as day turns to night. I remember walking down Ocean Parkway in Brooklyn on fall evenings when I was a child, carrying home a loaf of rye bread still warm from the bakery. The streets were filled with men coming home from work. Men carrying brief cases and adult concerns. I want to be a child among them now, comfortably invisible, my hands tucked into my pockets, a loaf of warm bread nestled under my jacket, cool fresh air with the smell of burning leaves in my nose, knowing that when I get home there will be a hot bowl of soup waiting for me.



Dr. Fish’s nurse –receptionist calls the next day. The test results are clear. The hotspots were pockets of arthritis from old sports injuries. There is no spread. I let her words roll down over my head like hot fudge over ice cream. I feel so lucky to merely have prostate cancer.

III
“Chemical Eunuch”

It was my oldest friend’s older brother who led me Hormone Deprivation Therapy. It works against cancer the way cancer works against a healthy body. It starves it of its food supply. It creates the ultimate embargo. Unfortunately, its food supply is testosterone; the very hormone that defines our maleness.

To prostate cancer cells testosterone is nature’s most perfect food. It is like spinach to Popeye. Like mother’s milk. And in the Garden of Eden into which they are placed, their entire environment is edible. Imagine living in a city made of chocolate.

Within six months, a man’s hormonal chemistry most closely resembles that of women in menopause. We experience hot flashes. Night sweats. Muscle tone evaporates. Fat accumulates around the middle. The threat of osteoporosis increases. Some men experience breast enlargement. (If that happens to me, two friends of mine want to date me.)

In the twelve months I was on the medication my PSA shrunk like the Nasdaq, down to 0.02. But not without a price. The normal level of testosterone is 500-600. At the end of a year, mine was ten. Libido is gone. Not only is the sex drive gone, but the desire for the sex drive is gone.

Women, whose bodies in the past would have stimulated longing and desire, now generate no more response than the sight of uncovered furniture. Unaided spontaneous erectility is a distant memory. That Saturday Night Special, decays into Flaccido Domingo. There is something strangely liberating about being immune to physical stimuli. We see women’s sexual machinations without coming under their thrall. It’s like seeing a puppet show from backstage. You see how all the tricks are done, but the magic is gone.

The other downside is that hormone deprivation does not kill the cancer. For that, a coup de grace is needed, the implantation of radioactive seeds. For this, I have decided to go to Seattle, home base of Dr. John Blasco, who has pioneered this procedure called Brachytherapy.

IV
“The Coup de Grace”

As you fly into Seattle, you can see Mt. Rainier in the distance. A mantle of snow glimmers off the crest. Traffic from the airport is light and the ride into town takes less than twenty minutes. My driver has a long black beard and a blue turban and speaks in that lovely cadence of the subcontinent. He finds my hotel easily. It’s located in a district called “Hospital Hill, which is aptly named for the dozen or so hospitals clustered within a few square blocks.

I am buzzed through the outside glass door into the musty vestibule. Streaks of weakened sunlight struggle in through layers of window soot and velour curtains. The smell of something cooked in the 1940’s permeates the velvet nub of purple carpet. The man checking before me wheels an oxygen tank alongside him on a shopping cart. He is frail and blotched. He looks like a stunted tree with patches of fungus on its bark. I keep myself at a distance, not wanting to breathe the same air. I am not like him. I am healthy.

His wife fusses over the arrangements. She moves with difficulty and seems cross with everything around her. I wonder what binds this couple. It can’t just be their shared maladies. They could not have expected to end up this way. Yet there is a strange testy affection between them, even if they have to repeat everything four times. Maybe that’s the secret. Less communication

I don’t know why I didn’t let Patty come with me. She wanted to. “I know why I said I didn’t want her to come: First of all we’d have to stay someplace nicer if you came. And you’d pack too much and we’d have to check bags and I hate shlepping stuff and I just—“

She wasn’t buying any of it.

“Maybe you just don’t want to be in a relationship,” is where the argument ends.

I find strange solace in the anonymity. In my last dream before waking I am strapped to a log on the St. Lawrence River, and one of those buzzsaws was cutting off slices of my leg. Tough one to interpret. At six A.M. I follow the directions on the little green fleet enema box. I will spare you the details except to say that if all consumer products were equally effective we’d be a happy nation.

I walk to the hospital in the bleak and warming early morning sunlight. I take the elevator to the Seattle Prostate Clinic. I’m greeted cheerfully by the nurse, who calls me by name though we have never met. She asks cheerfully whether I’ve had my enema, and I answer cheerfully that I have. We’re all so cheerful. I am given a gown to change into and told to empty my bladder. In the restrooms of the prostate center all the toilet seats are up.

And suddenly the eighteen-month waiting is over. I am not just “going to Seattle” as I had blithely referred to it. I am receiving final treatment for cancer. I walk under my own power across an interior ramp to the operating theater. I meet the anesthesiologist. He administers a spinal and I am numbed from the waist down. I am wheeled into the operating room.

My feet are placed in stirrups and a long thin needle is inserted.

I close my eyes and listen to the sounds of the procedure going on all around me. The seeds are placed into the needle. The computerized map leads Blasco’s sure hand. He has done this four thousand times. This is my first and only. I encircle myself with images of people who love me; old dear friends and family. My students. Annie, my daughter. My mother is not there. I have not told her about any of this. It is not out of altruism. I cannot bear the weight of her concern.

It goes better than planned. The hormone therapy was so effective that only half the number of seeds were needed. I asked if that meant I’d get a discount. A couple of hours later I’m walking out under my own power. I take a taxi back to the hotel. The feeling has come back to my legs. My tush feels like I’ve given birth rectally to a porcupine, but that eases up as the day progresses. I’ve been given a little coffee filter to pee into the first few times and a little lead canister to retrieve any of the radioactive seeds in case they come dislodged and get peed out.

Twenty-four hours after I arrived, I get back on the plane to Los Angeles. I wonder, when all this is over, when radioactive seeds have killed the cancer and I’m off the hormones, and my testosterone returns to normal levels, whether I will become again the man I was, or are we all merely products of our chemistry. What makes a man a man?

As Mt. Rainier retracts into the distance, I recall the day when I told my daughter that I had been diagnosed with cancer. Tears shot from her eyes like they had fifteen years earlier when her mother and I told her we were getting divorced. She had not sat in my lap for years, but she ran across the room to me and threw her arms around me and cried. I made her look at me and told her that it was going to be all right; that I had waited until I knew that it was going to be all right so that when I told her she would know that it was true. A mother has a child’s love whatever she does. A father has to earn every small moment of it, by explaining and making safe for his child a world that still frightens him and that he’s never understood.

The landing gear shudders into place and I am jostled into half-wakefulness. The plane settles down into the familiar hazy blanket of smog and headlights. Traffic is light on the way home. There are lights on in the house when I get home. Annie has waited up for me.

She has made me hot soup.

Previously published in My Generation, a publication of AARP



Hal Ackerman has been on the screenwriting faculty at the UCLA School of Theater, Film and Television for eighteen years. As a screenwriter he has sold material to all the major studios and tv setworks. His book "Write Screenplays That Sell the Ackerman Way" has gone into its second printing and is endorsed by his many successful proteges. His prose fiction and poetry has appeared in many journals, most recently "I Wanna be Sdated", "30 Writers on Parenting Teenagers". A theatrical version of "How Prostate Cancer Made a Man of Me" will open in Los Angeles this fall. Photo by Annee Ackerman.
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