By Mort Laitner
Walking in to Dr. Dunn’s Office, I noticed his collection of 1940’s railroad art. Giant steam locomotives sped through mountain passes. They belched black smoke into the crisp Rocky Mountain air. These powerful monsters gambled with traveler’s lives as they climbed steep heights at break neck speeds.
Breaking my trance was the sweet voice of my urologist’s receptionist, Terri. She greeted me with her infectious smile, her silky brown hair and her syrupy Southern accent, “Good morning, great seeing you again. How y’all feeling today?”
I remembered how Terri loved to talk. She gave out medical advice like a chain- store pharmacist on a Saturday night.
“All is well,” I replied as I twice tapped on my head to ward off evil spirits.
“Just here for my annual checkup.”
“At your age that’s a good idea. Never hurts to know how all your components are operating. Today we got screenings for all parts of your body. We got this PSA test for detecting cancer in your prostate. That’s a gland in the lower part of your body.” As her eyes scanned to a spot six inches below my belly button, her words chugged along as if she were a train running down the tracks. “The letters stand for prostate-specific antigen. We just draw a little blood from your arm. If your PSA comes back positive then we do a biopsy to see if your cells are cancerous. But before you get screened you got to understand your goals, your fears and your willingness to accept risk.”
As I wondered if she had gone to PSA training, I said, “Honey, that’s a mouth full of assignments and a lot to think about.”
Terri continued, “You don’t have to make up your mind today, just sleep on it. You can always come back for the screening.”
“Terri, let me tell you a story about a friend of mine who just had his prostate gland removed and he is incontinent and impotent.”
I queried, “Want to hear how the whole process started? A urology practice gave him free tickets to a pro basketball game in exchange for getting a PSA test.”
“But he is still alive— isn’t he?” she retorted.
“He is still alive but he is one unhappy camper. Terri, the man wears DIAPERS! Terri, he lost his MANHOOD!”
Pausing to scratch my mustache I continued, “His urologist’s mantra was ‘detect early and treat effectively.’ His doctor counseled, ‘You do not want to be destined to suffer and die.’ Before his surgery he read an article calling incontinence and impotence unpleasant side effects. His wife calls them disasters. Can you imagine that? He slid down that slippery slope the minute he heard his test results. He could not live with the anxiety of a cancer in his body. He had to remove it. He asked his doctor for surgery to be preformed the next day. You know what he is thinking now? That some cancers are better left undiscovered.”
Terri’s face reddened as she flung a black clipboard in my direction. The syrup in her voice turned to vinegar as she spat, “Fill out these forms and hand them back to me when you’re done.”
“Thanks,” I replied as I picked up the clipboard which had three sheets of paper pinched between steel and plastic.
Flipping through the pages I scanned their titles:
- Health Questionnaire Update,
- Medical Consent Form,
- Mathematical Probability PSA Screening Consent Form.
This third form intrigued me. Was the government trying to slow the expenditure of limited health care dollars? They knew the risk of death from prostate cancer was only a thousand to one. Was this the urologist’s attempt to avoid liability after a patient lost his ability to control his bladder or raise his manhood?
This new form only dealt with PSA screenings. It made me recall handicapping tip sheets at Monticello Raceway. But now instead of wagering on a horse and jockey I would be betting on my life.
I read the form with all the interest of a horse track junkie:
It has been determined that patients should have an opportunity to weigh and respond to health risks by use of mathematical probabilities. Since studies are constantly rendering new statistics we recommend using your computer to update all provided data and by visiting our website to learn more information. Here are the statistics:
90% of men who have a PSA screening have normal results;
10% of men have abnormal results:
Of that 10% there is a 40% chance that a biopsy will show cancer;
There is a 60% chance that the elevation is due to benign causes, such as enlargement.
WE ARE STILL AWAITING RELIABLE RESULTS FROM VALID CLINICAL TRIALS TO PROVE SCREENINGS ARE BENEFICIAL
At the bottom of the form, I rubbed my index finger over the ink:
“I have read this information and after evaluation have decided to:
Defer the PSA screening___ Accept the PSA screening___.
I thought about the unstated statistics:
What percentage of men become incontinent?
What percentage of men become impotent?
What percentage of men become both?
For a split second, I stared at the drawings of steam engines on the wall and thought “I’m not ready to hop on board this locomotive. I knew my goals, my fears and the meaning of black smoke.”