June 1, 2026
An “adventure” in health care (American style), part 5
Gary Engstrand
Pieces of a Prologue
An egregious
omission from this narrative is my wife Kathy. She has shared my concerns,
listened sympathetically to my sometimes endless fretting, and been a source of
support without which this entire set of events would have been far more
unnerving and depressing.
I know that I have a propensity for
imagining the worst outcomes and fret about the possibility. The treatment and
cure rate for prostate cancer caught sufficiently early is not 100%. I manage
to be concerned that I’m in the small percentage of cases where the cancer is
not cured. That I am wont to worry is odd because I’m usually an optimistic guy
and I follow my father’s oft-issued advice to my mother: “Betty, don’t worry
about it.”
My friend Sam got annoyed that I
alluded to Samuel Johnson’s (1777) quip. “Depend upon it, Sir, when a man knows
he is to be hanged in a fortnight, it concentrates his mind wonderfully.” I agreed
that it was true, I probably didn’t face the (figurative) hangman, but the
fleeting brush with death nonetheless made me think more carefully about how I spend
my hours. I have done so off and on for several years, as I realized my time
was getting shorter, but this medical situation revived my contemplation of what
I want to do and with whom I want to spend time.
I want to
note that my friend Sam, counselor and cheerleader all during the process, and
especially during the nerve-wracking months in Florida earlier this year, has
retained those roles as the weeks have passed. I remain grateful for the commentary
and advice. I’ve also failed to note the support from a retired faculty friend,
a bioethicist, who has been a recurring source of encouragement. Sam has told
me that he was more easily able to get through the process by talking with
people as he went along. I have found that to be true for me as well.
The Treatment Outcome
I tried
to describe earlier the machine that I have visited 26 times. With the
(laughing) consent of the technicians, Kathy took a picture of me lying on the
carbon fiber slab just before treatment began.
The photo
shows three of the four “arms” that come out from the head of the machine; the
fourth one is underneath me. The one over my pelvis is the radiation-emitting
arm. Once treatment begins, the technicians leave the room and go to the
control panel and those four arms go around me slowly four times, twice
clockwise and twice counterclockwise.
* * *
Numbers
in medicine can be traumatic. Think “stage 4” anything, for example. Numbers in
our lives, work or pleasure, can be disappointing or pleasing, but I think that
in most cases they are not traumatic nor do they render us ecstatic. Sales
might be up or down, your salary might be going up a large percent, the
estimate on the home repair came in low, your kid ran a marathon in record
time, ad infinitum. But at least for me, those kinds of numbers do not elicit
the same reaction as the ones in medicine that demonstrate my status and
likelihood of continuing to live. So yes, the numbers in medicine can be
traumatic—but they can also be exhilarating.
The magic PSA numbers:
Dec 30 13
Feb 6 17.7
April 13 27.4 (these numbers are going the wrong way!)
May 22 0.697 (this one did not go the wrong way!)
On May 20
Dr. Hirtz told me that he wanted to see the PSA number drop below 10. The May
22 number was significantly below 10.
I cannot
recall ever being so relieved in my life. When I told Kathy the number, she
asked me if I was happy. I told her that of course I was happy—but the overwhelming
sentiment was one of relief. I was extremely happy when I got married (both
times) and when the two kids were born; this case is less a matter of happy
than finally relaxed, for the first time since the end of December.
Of course
I had a number of questions, relief aside. At my last session with Dr. Hirtz,
he answered them but said that my urologist would have additional comments. Dr.
Hirtz is a really nice guy; I wish I could have him as my physician for any
other medical issues that may crop up in the future.
-- Is the drop in the PSA (from 27.4 on April 13 to 0.697 on
May 22) typical when a patient has started on radiation and hormone therapy?
It is.
-- Is it possibly a fluke in the test and should be
retested?
That is
highly unlikely, and further PSA tests will confirm the result.
-- What is the probability that this is a false negative?
Also
highly unlikely, but further PSA tests will show whether it is.
-- Assuming it is accurate, what implications does the 0.697
have for continuing treatment?
Primary responsibility for
treatment now passes back to the urologist, who will make that decision about
continued hormone therapy.
-- If I recall correctly, you said the PSA number will not
get to zero. Is 0.697 close enough to zero to call it a win?
It may get to zero, at least during
the hormone therapy, but it will likely return to a positive number. They are
satisfied with anything below 0.2, so it needs to be lower.
-- I ask this only half seriously: If, as you told me, any
drop in the PSA # this early would be due almost entirely to the drugs, not the
radiation, then given the numbers, one might ask what the purpose of the
radiation is 😊
The
hormone therapy doesn’t kill the cancer cells; the radiation does that.
Dr. Hirtz
also gave me an article from The Lancet (British, one of the most respected
medical journals in the world) about prostate cancer treatment outcomes, and he’d
even taken a highlighter to some of the language. Wow.
Dr. Hirtz
concluded by saying he still expected a cure, with the remaining hormone therapy,
and said I was in an excellent position.
* * *
As the
radiation and hormone therapy was progressing, I told my friend Sam that everything
at Planet Fitness was harder than it has been.
I think that’s attributable to two
factors: (1) I was only at a gym three times in the entire month of April, and
(2) the radiation, which my radiation oncologist cautioned me would likely
happen: a loss of stamina. I went for 3 minutes on the treadmill at my usual 8%
gradient and 4.1 mph and thought I was going to collapse at the 3-minute mark.
I did 3.8 mph the second time and I could handle that. The 20-pound weights
felt like 30. The 120 pounds on the leg press felt like 150. I imagine it is
important that I keep up a regular exercise regimen or this cancer treatment
will leave me much worse off physically than I want to be.
As of late May, the situation was about the same. I received
an interesting piece of advice from my son Elliott (self-taught expert on
fitness whose judgment I have come to trust): since cardio conditions decline more
slowly than muscles atrophy, for the time being focus on weights and strength
and muscles more than on cardio. I am following that advice.
* * *
After 26
days of treatment, I got to know the technicians who administer the radiation.
There were six of them (I was told); they work in two-person shifts. Over that
many days, I met all of them several times. On my last day, one of them, an
older woman (who told me she was going to her grandson’s first birthday the
next day) gave me a hug. That was sweet. So were the donuts I brought them that
morning from our local bakery.
* * *
As I
noted, my oncologist Dr. Hirtz passed me back to my urologist Dr. Olin. I spoke
with the latter this morning. He told me that everything is going well and
expects the PSA level to be “undetectable” at six weeks after the radiation
ended on May 22. He cautioned me not to focus too much on the PSA; it’s merely
a reflection of the situation at the time.
Dr. Olin also told me that the
hormone therapy will continue for at least 18 months, it’s better to do it for
two years, and optimally for three years, to be sure the cancer is eradicated. Some
men have such adverse reactions to the hormone drugs that they stop after 18
months or two years. I’ve had very little reaction, so I suppose I’ll go the
full three years. I guess I can put up with six pills per day.
Given what Dr. Olin had to say, I
have no reason to think there needs to be a “part 6” to this story. Now comes
simply the continued hormone therapy and a predicted positive outcome. If you’ve
taken the time to read it all, thank you. It’s been therapeutic for me to write
it.
A Last Digression on Word Choice
A friend,
also going through cancer treatment, wrote that “I particularly resonated with
your questioning of the various word choices. Journey and battle never
resonated with me either. It’s more enduring because so much is being done TO
you with very little that you can contribute (other than keeping your body and
mind in as good as state as possible). Battle is also wrong to me because there is very little
fighting. It’s a lot of surrendering, surrendering to this road that we are on.”
Instead of the events planned in her life, “I got detoured onto this bumpy gravel,
potholed, uphill road.”
Another
friend suggested I am on an adventure, as I titled these narratives. In retrospect,
I realize that was an inapt choice. "Adventure" to me implies an
activity that is new and interesting and fun. This is new (but unwelcome),
interesting (not in a way I like) but it is certainly not fun. I have retitled
these stories: An “adventure” in health care, which presumably implies sarcasm
or skepticism.
