Put to the Testicle

Around the time of my uneventful 31st birthday, and months later than I should have, I searched online for testicular cancer symptoms and found I was oh, five-for-six.

Around the time of my uneventful 31st birthday, and months later than I should have, I searched online for testicular cancer symptoms and found I was oh, five-for-six. Increase in size. Check. A feeling of heaviness. Check. No pain early on. Yup. On it went. I had a growth, shall we say, and could no longer ignore it. As I clicked around, my mind recalled some notable testicular cancer cases: Baseball player John Kruk, diminutive figure skater Scott Hamilton, jug-eared comedian/actor Richard Belzer, and of course cyclist Lance Armstrong.

I had yet to even call a doctor, but it seemed that this very well could be testicular cancer. Sure wouldn’t be from overuse if you know what I’m saying. As unpleasant a possibility as this was, my fear was tempered a bit by learning that it’s one of the most successfully treated cancers. I tried to determine through my research whether that’s because it strikes a disproportionately young group, or whether it’s a fundamentally different cancer that is more responsive to treatment. The answer, particularly because there are different types of testicular cancer, is apparently a little of both.

But fellow average white guys should pay heed: Although it accounts for only one percent of all cancer cases in men, testicular cancer is one of the most common among men ages 20 to 40. For as-yet undetermined reasons, white American men have a four times greater risk of the disease than non-whites, and the number of cases continues to increase.

Like many guys in their 20s I had gone years without giving a doctor visit a wink of thought. After moving to New York, I’d gambled with little or no health coverage for a few lean years spent waiting tables while going to school. When I began working full-time, I regained some coverage, and even had my first physical exam since I was a strapping 4’ 9” high school freshman. All checked out well, yet only a year or two later here I was in my general practitioner’s office again, not knowing what to expect. (As it happens my GP was my roommate’s second cousin, or something, and now that I had a potentially serious problem, I learned that he’d earned his medical degree in Grenada, I reckoned in between surfing and keggers. But he was my GP; what harm could he do.)

Cancer somehow seemed so improbable that I allowed (perhaps forced) my mind to drift while I waited in the chilly examination room. The bad fonts and horsey layout of the Circulatory System poster began to bother me. I was regretting my high school yearbook senior quote when he walked in and I made myself tell him why I was there. Moments later I’m hearing “Jesus. How long has it been this big?”, not encouraging. “Call work and tell them you’ll be here a lot longer today. We have a bunch of tests to run but either way you’ll know what it is before you leave today.” He poked his head back in the room. “You have to be prepared to hear that this is cancer, so...” And again, turning back to me, “Either way, I mean whatever it is, it’s gotta come out.” A muzak version of Procol Harum’s Whiter Shade of Pale played as I walked over to Radiology. It wasn’t really that bad actually.

Choking down a frothy bitter-lemon barium solution to provide imaging contrast for a CT scan, I found myself pondering the prospect of prosthetic testicles. A trifling curiosity in the larger scheme of things, to be sure, but one wouldn’t want to not ask merely out of fear of appearing to have skewed priorities. I sure didn’t want to have some doctor tell me months later that of course I could’ve had a fake nad, and why hadn’t I asked? So when I met with a urologist later that week, I did. His answer, alas: Ever since the silicon breast implant cases ten years prior, manufacturers were increasingly reluctant to produce prosthetic testicles. Rats. I pressed on, hoping to hear something like “Ok pal here’s what you do.” He’d poke his head out of the room to see if anyone was coming. “Contact Dow labs at this number, ask for Chuck in Medical, tell him Marty sent ya. Password — you’ll need this — ‘teabag’ and you’re in.” But no such luck. He said that I can always get myself one should they go back on the market, but I won’t be submitting myself to another painful outpatient procedure just for scrotal symmetry.

The urologist determined that this was, in all likelihood, cancer, and scheduled me for an inguinal orchiectomy, which even sounded vaguely painful. I was not to find out about further treatment until after the surgery; a pathologist’s examination of the tumor would determine which particular sub-type of cancer I’d contracted, which would in turn inform doctors’ decisions regarding post-operative treatment.

Once I knew I was going under the knife, I e-mailed family and friends to notify people in a quick and easy message titled something like Nad News. Most of my friends had a similar reaction, such as “But dude of all our friends you’re probably the most in shape and aware of your diet and everything.” One of my friends from college was convinced it was a by-product of my taking the potent prescription acne drug Accutane a dozen years prior. Who knows.

I had just recently exchanged a few e-mails with one of my brothers about our large clan’s good fortune in the absence of some rogue cancer gene floating around either side of the family tree. Our sister-in-law had recently learned that her mother had been diagnosed with pancreatic cancer, and given mere weeks to live. Her funeral was held the day before my surgery.

In the two weeks before tumor removal surgery I researched what was ahead. There was more information online than I could process. I also contacted a high school friend’s older brother for more information, as I recalled that he’d had the disease when he was in his twenties. I learned that he’d actually had it twice, a few years apart, receiving chemotherapy both times. Though now completely healthy, he gets a testosterone shot every week or so for the rest of his life, as both of his testosterone-producing organs have been removed. He gave me a great deal of information about chemotherapy options and drug combinations. In answering matter-of-factly my questions and explaining his treatment and side effects, he made me appreciate that this was serious shit. He was also very grounded and positive about his multi-year ordeal; and I no longer treated my situation as blithely as I had.

The likely course of my next few months began to sink in. Everything I’d read seemed to indicate that there was a 50-50 chance I’d need chemotherapy. If I was very lucky I’d have one surgery, followed by radiation. If not, my surgery would be followed by a second, more serious procedure (this one to remove abdominal lymph nodes, where this cancer often spreads first), followed by chemotherapy. I began to look ahead to the coming months; possibly seven months of my life down the tubes just like that. I knew this thinking was weak, especially given my great good fortune in having access to the best cancer care in the world, but it was hard to get my head around.

My parents drove up for a day or two to take part in the fun while one of my brothers happened to be traveling through the area that week, which worked out well. So three people accompanied me to the hospital, where I changed into a powder blue gown, slippers, and a floppy hat resembling a loose shower cap. Unable to resist appraising myself in the mirror, I thought the hat rounded out the whole look quite well. I had three vials of blood drawn and, having fasted since the night before, very nearly passed out. My need to save face among the nubile nurses kept me conscious, just. My urologist, who was to perform the surgery, quickly popped by to say hello; I was glad to see he had to wear the hat too. Since it was a sunny April morning, I found myself hoping his mind wasn’t on his afternoon tee time.

Propped up on the gurney in the waiting room, I was handed a consent form to review and sign. I quickly scanned my urologist’s notes, the most prominent of which was a capital “L” loosely enclosed in a circle. My stomach sinking, I deciphered more of his writing to read something to the effect of “...L mass, cancerous, prescribe inguinal orchiectomy for removal.” Unless the L stood for large, which the thing certainly was, his notes were cause for you know, alarm. I waved a nurse over and asked her to confirm some specifics. As I watched her nod into the phone while she double-checked my form, all those horror-story newspaper blurbs I’d read over the years popped to mind in rapid succession: A surgeon removing a guy’s perfectly healthy right foot rather than his gangrenous left one; some poor bastard having the wrong kidney taken out. The nurse returned from the phone with a chirpy confirmation that left is correct, to which I replied “Whoa whoa whoa! No! Right. Not left. Right! Droit. Derecho. Starboard. Can’t miss it, trust me.” Back to the phone she went. Once assured that we were square, I signed the form. Though I couldn’t resist groggily clarifying the matter one last time as my doctor put me under. I didn’t want to stake my future reproductive life on the faith that his wife poured him his usual coffee that morning rather than decaf by mistake. My kids might thank me someday.

The only discomfort I felt when I awoke was a sharp pain in my lower back, from being in the same inclined position for a couple hours. I was wheeled into the outpatient recovery room for a couple hours’ convalescing. Woozy, I scanned the room and felt a bit better when I saw the shape that most of the others were in. A dozen of us sat propped up, looked drowsily around, wondering what each other had. It wasn’t until I threw up that my wound and I were properly introduced. The incision, not unlike a C section or an appendectomy but lower down, felt like an O.J. knife had been plunged into a groin muscle. Having lived a relatively injury-free life, this was easily the worst pain I’d ever felt. Though my wound now pounded with pain, I no longer felt groggy, and I soon signed the release form, asking the nurse if I should just sign it as “Lefty.” She didn’t respond but she probably didn’t know what procedure I’d just had.

A couple days later I got up the gumption to peek at the incision, stapled shut and reminding me of something from one of those Hellraiser movies from the 80s. I could slowly move around my apartment but only in a boiled-shrimp posture; I couldn’t come close to standing upright. It looked like I wouldn’t be doing squats for a few months. And needless to say I was careful not to sneeze or cough.

I’d expected to be back to work after missing a couple days but found that four days and a weekend had passed before I had any hope of shuffling outside. I hadn’t expected to be immobile for so many days. It turns out the only truly bad moment in my months-long process was brief: My surgery had been on a Wednesday, and by Sunday night I realized I wouldn’t be able to work the next day since I still could barely walk. That night I felt completely alone, and in my darn-the-luck frame of mind, wishing I had a girlfriend to take care of me, I cried quietly. _Read part two: http://bit.ly/testies2_

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