Here is chapter 2. I've changed the title to Pilot Beats Prostate Cancer. Please excuse bizarre changes in size of type that occurred as the text transferred to this website.
THE DIAGNOSIS
VIVIAN
We were a storybook tale, really. The groom, a handsome sixty-two, after thirty years as an airline pilot, marries pretty and popular trial lawyer, age fifty, on the grand staircase of Alaska's one and only world-class ski resort hotel, surrounded by friends and colleagues, and the local relatives.
The wedding took place only four months after the groom's last flight in the cockpit of a 727, from Anchorage to the Russian Far East, and the official retirement party held at his favorite Anchorage honky-tonk, the Buckaroo Club, which has a very good country Western band. The pilots’ union picked up the tab for the party.
Everything was working out for us, after many years of loneliness.For the groom, twenty years since "my wife divorcedme." For the bride, seventeen years since "I gave up onmarriage." And suddenly, we had that remarkable blessing, a happy marriage.
We were very busy. Don’s long-established plan was to move out of Alaska upon retiring from commercial flying. He hadn’t expected to meet a nice woman and get married. He asked if I would consider closing my law office and moving to California. I agreed to phase out my legal practice and move to Sacramento, where Don had two houses, one empty, one rented out. But I wanted to keep a place in Alaska because until I met Don, Ihadn't even thought about retirement, and I figured that I might not like California, a strange place where I would not know anybody and nobody would know me.
We reached a compromise. I had a half-acre of land in the forest, seventy-five miles north of Anchorage, in a place called Willow, and Don had a cabin out behind his house in Anchorage, that he was using for storage. We decided to move the cabin onto the land in Willow before we sold the house. Then we would always have a place in Alaska to come back to. It sounded pretty simple.
Two excellent surprises were waiting when we drove out tosee my land, which I had not even visited for years. One, thedirt road winding through the forest to my land had been paved,after thirty years. No more mud baths and rocks blown at us bypassing pick-ups as we drove through the birch trees. And two,a developer had built an outstanding airstrip within walkingdistance of the land, at the center of an aero park with 3-7acre lots. Don had an old bush plane that he might tie down atthat airstrip. He was having trouble with his tie-down atAnchorage International Airport.
DON
There is some kind of a vendetta by field maintenance out there. I've had that parking space for my plane for ten years. I've always paid my fees on time, and I've kept the area neat. All of a sudden a woman with a clipboard is coming around and writing up all the planes that aren't flying. This is unusual because usually the tie-down office could care less.
VIVIAN
It all fit together. It was even a perfect fit. The marriage, someone to retire with, to have fun with, to build a cabin with. Land for the cabin next to an airstrip, a plane in need of a new home. Winters in California, summers in Alaska.And we each had two grown sons, all four of whom were workingand taking care of themselves. It doesn't get any better than this.
So we went right ahead with the plans. We met with the owner of the Tesoro gas station in Willow--who was reputed to be the best excavator in the area--and we ordered a driveway, a site for the cabin, a water pipe ten feet down, and a septic system. And after a year he finally got his crew out to the property where they did a primo job of designing our little settlement. Three really grungy guys on heavy equipment punched a curving driveway along the edge of the slope leading down to L'il Honeybee Lake, and hollowed out a spot for a basement,suggesting that we put the cabin on top of a full basement, so that we could look out at the lake through the treetops. They put in a septic tank and installed pipes, cleaned up the fallen trees and smoothed out the ground they'd torn up, all in a few days. And they did not damage one square foot of the land beyond what had to be disturbed. Don and I were amazed.
All but one of the men who worked on our cabin from that point on were true craftsmen. We were very lucky.
We spent the first two years of our marriage traveling backand forth between Alaska and California, repairing the houses at each end, and building the cabin. We also visited relatives in the East, the South and the Midwest. We were as busy as we had ever been when working for a living.
I struggled to adjust to California. It is truly a weird place. The traffic is insane and the politics are off in someother dimension. In Alaska a school scandal consists of a male English teacher having sex with a 16-year-old girl in the music room. When he is caught, Anchorage police overrun the administration building looking for evidence that other teachers knew what he was doing, which they did. The school district sues the police department for invasion of student privacy, an action which a judge throws out after school district lawyers have made a million dollars of taxpayers' money. The teacher threatens to sue the school district, so the district rewards him by giving him a full early retirement. Another judge rules the teacher not guilty of crime, so the Alaska Legislature passes a law which will make it a crime for teachers to have sex with students in the future, even if said students are over the age of consent.
By contrast, in California a school scandal consists of a male teacher who decides to have some surgery and hormone therapy to convert himself into a woman. He or she discusses the matter with his or her students. This sharing of the experience gets back to the parents, some of whom object. The students react by picketing in favor of the teacher, whom they feel should be allowed to return to the school as Miss ----instead of Mr. ----. After all, we should all have the right to do what makes us feel good about ourselves. The teacher threatens to sue the school district, so the district rewards the teacher by paying her a substantial settlement, and she moves on to another school in a part of the state where a sex change operation is covered by the municipal insurance policy for employees.
For some reason I can relate to the Alaskan school scandal, but I cannot relate to the California controversy. However, in spite of the overall spaciness of the collective California consciousness, the people as individuals are very nice. They are friendly and easy-going.
We were in Alaska when Don felt the first symptoms. He did not share his problems with me because I was recovering from two surgeries myself. We both fell apart in the same year. He made an appointment with a urologist, and came back with a PSA of 24, which is really high, and bad news on the physical exam. Then he told me about his past abdominal problems.
DON
I had problems about fifteen years ago. I went down toVirginia Mason [major medical center in Seattle], and the doctor gave me the finger wave. How does anybody feel about the fingerwave? Most guys would rather have somebody take 'em out behind a barn and work 'em over. That's why the PSA blood test has come into its own. If you have a normal PSA, 4 or below, you're not subjected to the finger wave, although some doctors will do both.
The doctor at Virginia Mason took the PSA after he gave me the finger wave. I flew back to Alaska and he sent me a letter. When I got back down there he chewed me out because I took so long to come in. I showed him an article that said he was supposed to take the PSA before he gave me the finger wave, and it said that there was no hurry with treatment. That was when the PSA first came out. He gave me the PSA again and it came out a 4, which was within normal limits.
I had more problems a few years later, and I had a CAT scan in Anchorage, but it didn't show anything. A urologist did a sonogram, but I told him, 'If you don't see anything, I don't want a biopsy.’ Guys get infections from those things. He didn't see anything. Now I find out that prostate cancer doesn't always show on a sonogram."
The last doctor I saw for my blood pressure, he told me to see a urologist because my PSA was 18, but I ignored the guy. I told him, “I've already seen a urologist and I've already had asonogram, and they didn't find anything." I like the doctor whogives me my FAA physical every year. He is a surgeon who decided to just do FAA physicals. It pays pretty good money and he doesn't have to have malpractice insurance. He gives you an honest physical for $60. It's a racket.
VIVIAN
It was October when Don got the initial diagnosis, and a recommendation that he proceed with a biopsy immediately. We had to decide whether to stay in Alaska for his treatment, or return to California. As usual, he opted for warm weather, regardless of all other factors. The problem was finding a doctor. We had no idea how to do that. Most of the medical care in California is delivered through HMO's. We were not in an HMO. Also, the ability of a surgeon who is going to hack into those critical lower regions is...critical!
This was the first crisis. I decided to pray about it. Voila! The next morning an idea came to me. Call Don's cardiologist in Sacramento, for a referral. His secretary told us that he could not make such a referral, incorrect procedure, etc. We left the message anyway, and two days later the doctor called with the name of "the surgeon I would go to if I had aPSA of 24." He even called ahead to tell the surgeon's office that we were "reasonable people with reasonable insurance." Thank you doctor and thank you, Jesus.
The appointment in Sacramento was set for one month from the day we called in. This was a precursor of scheduling to come. Everything took time. The cardiologist explained at a subsequent appointment that several urologists in the area had retired early because of conditions in the California medical system. We ran into those conditions three months later in the hospital.
Don had time in Alaska to finish working on the cabin, and his plane. An electrical crew ran a line into the cabin at the end of October, so that our carpenter could leave his generator at home when he came to finish out the interior in the spring. Don had repaired a crack in the fiberglass engine cowling of his plane earlier in the summer. He repainted it, installed it, and covered it with an engine blanket just before the snow started to fall. I made one last appearance in court on a case that needed occasional tending.
We were both scared. The diagnosis of prostate cancer would not be confirmed until Don had a biopsy. He wanted to wait until we saw the surgeon in California because he figured that the surgeon who would operate should do the biopsy. Also, he was afraid of infection caused by the biopsy. The doctors say that infection is rare, yet our senior pastor in Anchorage had almost died from such an infection weeks before Don got his initial diagnosis.The pastor was in the hospital, fighting for his life, hours after the needles went in. Naturally, dozens o fthe faithful set up a prayer vigil and he made a quick recovery.
The stress of waiting was horrible. Don had all kinds of symptoms--headaches, back pain, insomnia, umpteen trips to the bathroom. Sex became impossible, painful.
Finally, we were in the surgeon's office in Sacramento. We read the diplomas and degrees on the walls. The doctor had impeccable credentials: surgical training at one of the top medical colleges in the world, the ultimate residencies.
Thirty-five years of experience.He was teaching at the UCDavis Medical School. Thank you Jesus again.
DON
I knew I'd found the right place when I walked into the waiting room. It was a urologist's office. There was a bunch of guys sitting there just like me: middle-aged, with scared looks on their faces."
That second finger wave! Forget it. But I actually liked the guy, especially with a middle name like Lenin. The main thing I was worried about was whether the cancer had gone intothe bone. I had lower back pain, and I never had it before. It was a foregone conclusion that I had cancer.
The biopsy was uncomfortable, but it was tolerable. You lie down on the table on your side, and the doctor has a sonogram TV monitor off to the side. He took five samples with the needle. Five separate times he hit me with it. Afterwards I was slightly swollen in the area, but there were no other effects. He did a perfect job.
VIVIAN
When we went into the surgeon's office, and Don filled outthe patient information form, he listed his name and occupation--airline pilot, retired--and wife's name and occupation--lawyer. So after the physical exam and biopsy, there we were in the examining room, doctor, pilot and lawyer. Or we were a surgeon, a cancer patient, and the patient's wife. The surgeon wasabsolutely a take charge guy. It is impossible for anybody to take charge of Don, and I cop an attitude at times, so the appointment was over the top on the stress meter. The doctor's preliminary diagnosis was bad-to-very-bad, scheduling-more-tests. Gleason score: 3+4=7. Stage B2. Dicey, very dicey.
DON
I felt that the surgeon was very thorough because he had a tolerance where he required the bone scan, and I definitely fit in that tolerance. If the bone scan was positive, there was no reason for him to operate, because the cancer had already escaped the capsule. If it had gone to the bone, it was too late. I had three years to live. That's the average time it takes to do you in.
I had really bad back pains, which I never had before. The doctor just blew them off. Apparently he didn't think they were very important. As it turned out, they were definitely symptoms because they disappeared after I had the operation.
VIVIAN
All of the books on prostate cancer, written by doctors, mention the importance of the wife to the treatment of the husband. I did not need that affirmation. From my point of view, I had the right, and the obligation, to ask as many questions, and provide as much information on Don's condition as he did.
So I said to the surgeon, as I had said to my own doctors when I had surgery the previous summer, "We are Christians, and we believe in the power of prayer."
A crumby expression--a look of annoyance or distaste or impatience--passed over the doctor's face. My own doctors had merely smiled tolerantly when I brought faith into their offices.
I did not back down. The most brilliant doctor in the world can use some help from God, whether he knows it or not ,and even if his middle name is Lenin.
"I've heard that before," the surgeon said. "I've even had priests in here, saying the same thing. But the cells are goingto do what they're going to do."
Massive unbelief. However, God is bigger than the doctor. However, Don was a little worried about any potential conflict between the wife and the surgeon.
DON
I stood behind you, of course. The doctor was polite about it. He didn’t tell us not to pray. He didn’t bolster you but he didn’t ridicule either. All he knew was what he saw. He's not a religious person--you can say that--at least not our religion. I just felt that you shouldn't antagonize him because he's got the final say-so. He's got the knife.
VIVIAN
It was late in November. The next appointment was for after Christmas. So we would spend Christmas waiting for test results to determine whether it might be our last Christmas together.
We decided to celebrate 100% of the season, as best we could. This was partly based upon my English mother's belief, which I espouse, that if you keep up appearances and routines during hard times, you will actually feel better and fare better than if you cave to the circumstances. It was also based upon faith that God would heal Don; perhaps He was already healing him. Lots of people were praying for us.
We put up a Christmas tree, mailed out packages of presents, filled the kitchen with goodies, etc. We moved slowly, but we got it done. Don's son suddenly introduced a serious girlfriend. We notified a friend that we could not makeit to her out-of-town wedding, because the bone scan was scheduled for that day. She understood.
DON
The bone scan was painless. They injected a solution into my veins. It gave me a little bit of a warm feeling at first, but it passed and I didn't even notice it. It is important that you draw a diagram of your body, and show all your previous injuries. I drew a diagram and put the date, the year for each injury. I am convinced that doing something simple like that will save you money. If you don't, and you have bright spots show up on your body, on the bone scan, they don't know what they are, and they'll do more tests.
The CAT scan was a no-brainer. Just lie on a table and they scan you. It took about thirty minutes, maybe less. It didn't tell them anything at all. It was negative.
VIVIAN
At the very end of the year, Don had the appointment that we'd been waiting for: the surgeon's decision. Could he operate? Would he operate? Was it too late? Life or death? And of lesser importance, but still pretty super important, if the doctor would operate, would Don still be able to operate in the bedroom?
The doctor had good news and bad news. The bone scan was negative. The cancer had not spread outside of the prostate gland, known as the capsule. The surgeon would operate. However, the pathologist who analyzed the tissue from the biopsy had rated the cancer as aggressive. Therefore, the surgery would be radical, practically as well as medically. The surgeon probably could not "spare the nerves," i.e. save Don's futureunder the sheets.
DON
Man, I was relieved. The bone scan was what I was sweating. I wanted the surgery, to save my life. I wanted it immediately. I wanted to have something done as soon aspossible because with my PSA as high as it was, I knew I'd used up most of my time. The doctor felt that he could do me more good with surgery. He felt that the cancer was still contained in the capsule. He said that there was a good chance that I'd have to have radiation after the surgery.
If I had it to do over again, I wouldn't stop at the first urologist that checked me out at Virginia Mason. I'd insist on a biopsy. Of course, at the time I had the first PSA test, the biopsy wasn't as simple as it is now. It wasn't out-patient, in the doctor's office. You had to check into the hospital. Another thing was, they were just starting to accumulate the numbers and the data on the PSA, so most doctors weren't even sure what was normal.
VIVIAN
The surgery was scheduled in thirty days, at the end of January. We had time to put our affairs in order.