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Saturday, May 31, 2014

Fringeville #107, May 31 2014

(Note: two days after my last post I underwent a robotic prostatectomy at Penn Presbyterian Medical Center in Philadelphia. The surgery was the right choice for me, but every prostate cancer case is different. I have learned it is a very complex disease. The preferred treatment will vary from person to person according to the stage of the disease, the patients age, and other factors. Please, please do not assume that my decision on the treatment for my cancer is the right decision for you or a loved one. Trust me: it is a process to arrive at the proper treatment. For those of you interested in seeing a robotic surgery, click here to see Dr. Lee perform one in Seoul, South Korea. Be advised that the video contains graphic material of an actual surgery, and may not be suitable for all viewers. I will work my way up to posting about my surgery and ongoing recovery, but for now I'm going to pick up where I left off: dealing with the diagnosis and its impact on my family and me.)

Timing is Everything...

Timing. That's the theme of this post.

From the disease standpoint, the timing has been incredibly good. My prostate cancer pre-surgery indicated that I had a moderately aggressive but locally confined tumor. The clinical stage (meaning the assessment of the tumor by way of all the evidence gathered before surgery) was somewhere in the Stage II spectrum. There are a wide range of possibilities under Stage II, and until a prostate is removed and examined by a pathologist there is a fair amount of wiggle room on a tumor's actual staging. The pathologist issues the final pathological staging of the tumor, and that may vary from the clinical staging. A tumor may be downgraded or upgraded, based on all the final reports and the findings of the surgeon during the procedure. (Click here for more information on prostate cancer staging)

My timing as far as getting the physical that started this whole shebang was also good. My previous PSA blood test was done in July of 2011. The PSA was an unremarkable 1.78 (PSA is a protein produced by the prostate gland. High PSA levels may indicate prostate cancer, however there are other reasons a man's PSA level may be elevated.) When my PSA was tested in February of 2014, it was 6.17 and that got my doctor's attention. It wasn't so much the higher number, but the rate of change over that relatively short period of time. That rate of change, called PSA velocity, was another indicator something might well be going on in my prostate.

Long story very short, that is what led me to the biopsy, which led me to the phone call that started all these blog posts when I hung up and realized I had cancer.

Which takes us back to timing.

How does one tell their family they have cancer? More precisely, when?

When I hung up the phone after getting the news, I realized I had to make decisions. Who needed to know? Who didn't? And when to tell them? And in what order?

My wife, of course, was at the top of the list. No one else would be told until I broke the news to her. Next would come my children, then my siblings and a very, very few others. That would be it initially.

So there, on this beautiful Thursday afternoon, I had to decide when to tell my wife. While I was pondering this, she texted me from work to bring her an iced coffee. Off I went to Dunkin, then down the road a bit to the daycare she works for.

As I waited for her at the door, I realized this was the wrong time to say anything. You don't hand someone a coffee and say: "Here you go. Extra cream & sugar. I've got cancer. I had them put a shot of caramel in there, too. Enjoy the rest of your shift!" 

No, this wasn't the moment. It would be horrible, horrible timing to drop that little bombshell on her at work. I would wait and tell her later. She wasn't expecting the results of my biopsy until the next day, so I just handed her the coffee and left and she suspected nothing.

When I picked her up from work, I realized I couldn't tell her in the car. Again, that would be horrible timing: "Hi, honey, how was work? Was it a good shift? The biopsy was positive. Wanna do burgers or pasta tonight?"

We drove home in silence.

As I prepped dinner, I decided telling her before we ate would also be horrible, horrible timing. Nothing kills that evening appetite faster than a cancer diagnosis. It would have to wait until after supper.

But after supper, I realized that I'd better wait a while. Nothing brings dinner back up faster than hearing your spouse has cancer.

No, no... I'd wait an hour or two, after my daughter, who always goes off somewhere in the evening to visit friends or catch a movie, left the house. That would be the perfect time to break the news to my wife. Then we could plan when to tell our kids.

Only my daughter stayed in that evening and the three of us sat in the living room watching god knows what on television for the next couple of hours. And I patiently waited for my daughter to go to bed, because that would be the best time, and as I keep saying, timing is everything.

Ten minutes or so after my daughter went to bed, I broke the news to my wife. Here's a condensed version of what transpired:

She:  You tell me this now? How can you tell me this now, right before bed? What horrible, horrible timing!

Me: Well, telling you at work didn't seem right. Telling you on the ride home didn't seem right; I didn't want you jumping outta the car. Telling you before dinner would have ruined your appetite. Telling you after dinner might reintroduce you to what you just ate. I wanted to tell you before I told our daughter, so that we could tell her together.

She:  But Jesus, right before bed?

Me: When, then? First thing in the morning? That's no way to start the day. "...Good morning, honey, I've got cancer, time to go to work. Have a great day!"

She:  But...

Me: When, exactly, is it a good time to tell someone you have cancer?

Silence, from both of us. You see, we'd just stumbled headlong into another of the laws of the Universe:  There is no good time to tell someone you have cancer.

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