Mr. Tomanek, perspective, prostate cancer and trains…

This is an excerpt of a book I am writing-101 Aphorisms, Adages and Illustrations for the Urological Resident–

See what you think.

I remember Mr. Tomanek for many reasons but for two in particular. He loved trains. He lived in the mountains just south of Helen, Georgia and built a garage specifically for his trains and all the stuff that goes with that. I looked at pictures of the new additions at each office visit. The other thing about him was the relationship between him and his wife. When I first met them, she had just had a base of tongue resection and all of the facial and neck incisions were healing. It affected how she talked and it affected her facial expressions. I was blessed to have worked with them for over 15 years. In the beginning he was strong and she was sickly. Then they were about the same and then he had a stroke making him weak and her strong. And man was she strong. She became, over time, the dominant part of the relationship. She did right by him.
What I have described, I have witnessed many times in my 25 year plus career; the ebb and flow of a relationship and the alternating pattern of health that accompanies it over time. Mrs. Tomanek seemed to become stronger as she aged and Mr. Tomanek deteriorated equally in reverse. Mr. Tomanek had a stent that we exchanged every six months because of a ureteral stricture secondary to repeated bladder cancer resections.
In time Mr. Tomanek became home bound and on Hospice and we elected to just “leave the stent be.”
One day there is a phone call from Mrs. Tomanek, “Dr. McHugh, Frank is having a lot of blood in his urine and I was in hopes you could just remove the stent and leave it out.”
“Sure,” I say, “when do you want to come to have it done?”
“Can you come here and remove it; at our house?”
I paused. There was no question that I wouldn’t accommodate Mr. Tomanek, I was just going through my head the logistics of having all the stuff I’d need to take the stent out and if I could do it by myself with her help.
“When do you want me to be there?”
My nurse and I packed up the irrigation fluid, the graspers, the light source, betadine and the flexible light source and I was on my way. I knew the area in and about Helen but the key was to turn just before Helen at a roadside vegetable market. As I turned on to the road, I said to myself that I would be stopping there on the way back to get some tomatoes.
When I arrived, Mrs. Tomanek, who had to be almost eighty, was at the top of a twenty-foot ladder adjusting a wire that was attached to her satellite system. It was crazy seeing this; I had my camera and took a picture of her up there.
She takes me inside and in an old fashioned bedroom replete with generations of pictures, was Mr. Tomanek in his bed gazing listlessly out the window.
I set up my stuff and luckily remove the stent without an issue. I give them the stent, “look, it’s a boy” as a souvenir. Mrs. Tomanek gives me a blue wooden train engine, “He’d want you to have this,” she says.
I never saw Mr. Tomanek again. I may have seen Mrs. Tomanek once since.
Rule: One of the beauties of years of experience is perspective. You develop a feel for how things “play out” because you have witnessed the evolution of relationships just as you have various diseases. This in turn makes you a better doctor.

Urologists know the good kind of prostate cancer from the bad from the get go…the patient doesn’t and it is our job to “get that message across” and educate, advise, direct and aid in the decision process and treatment with an emphasis aligning all with the patient’s wishes.