I heard you got cancer!

John, I heard you got cancer!

After I found out I had cancer, I decided that I would not tell but a few people. I had no reason for feeling that way, it was what it was, and it is just how I felt about it. I wanted to be able to say, “A few months ago I had my prostate removed, and everything’s fine now.” There was something about the telling of my situation after the fact and with hopefully a good report that was appealing to me. In a sense this method down-played my predicament and somehow lessened the drama of it to me. So when an anesthesia colleague of mine called me about a month after my surgery to go fishing, I found myself in a quandary. I had been back working for several weeks and essentially no one at my hospital knew that I had cancer, that the prostate had been removed, or that I was wearing diapers and leg bags. My partners knew, but I told them, “If anyone finds out about this, I’d like to be the one to tell them. Please let me decide that, so keep it to yourself.”  They took it very seriously to honor my request. In retrospect I am very grateful to them for respecting my wishes. If you think my concern about “who does the telling” is odd, it may well be, but consider an incident that happened to me during this time. Shortly after I informed my brother Bob, who lives in Atlanta, about my  cancer, he told a friend who lives in my home town of LaGrange, Georgia, who in turn told his brother. Bob’s friend’s brother ran into my brother Cooper in a grocery store in LaGrange and told him he was sorry about John having cancer. I had not told Cooper yet, so he calls me, disappointed and embarrassed to have found out about his brother that way from a casual friend in a grocery store. I now understand why H.I.P.P.A. (Health Information Patient Protection Act) is a big deal. Back to the story: I was in my office when my nurse said there was a phone call for me. “John, this is Tom and I was wondering if we could go fishing up at your river place this Thursday afternoon.” Fishing is my passion, so someone asking me if I want to go fishing is, as my mother used to say, “Like Br’er Rabbit saying to the fox, ‘Oh, please don’t throw me in the briar patch.’” The little cabin that Tom mentioned is a small structure on the Chattahoochee River near the Habersham and Hall County line, an area Sidney Lanier mentions in the opening lines of  his poem “The Song of the Chattahoochee”: Out of the hills of Habersham/Down the valleys of Hall… (My mother loved this poem; my grandfather’s home place was on the Chattahoochee River just south of LaGrange, Georgia.) The beauty of the place is that this area of river holds what some call Georgia’s unofficial state fish, the shoal bass. “Shoalies” behave like bass in their fighting ability and tastes for food, but live in and around rocks (shoals) in moving water like trout. They are a joy to catch with a fly rod. In the cabin I have several rods that I have made and all the necessary materials and equipment to tie all the flies with which I fish. To catch a fish on a rod you built and on a fly you tied, well, “It don’t get no better than that!”  Tom and I had gone fishing a couple of times together on the Chattahoochee River in this area. “Sure, Tom. I am up there all the time, so it’s no big deal. I’d love to go.” Then I realized that at some point during the trip, it’s about 30 minutes from my office, I’d need to change a diaper or expose my leg bag, depending on the collection device of choice for that day. (Something I learned while at the beach the week after my surgery was that if I am near water, I don’t have to wear any protection because any wetness on my shorts or bathing suit would be assumed to be water.) I had fished about a week before in some fishing shorts without a diaper, and it worked out well. I just let it flow while I was in my kayak fishing the section of the Chattahoochee near my cabin. “Tom, I need to tell you something; I had my prostate removed about a month ago, and I am still leaking urine. At some point in our outing I’ll have to either change a diaper or be wet, and I wanted you to know that now.” “John, what? I had no clue. For prostate cancer?” “Yes, it went well, I am fine, it was really no big deal.” My response and the information after the fact were executed just as I had envisioned. “Are you sure you want to go?” “Yes, its fine. I will just have to do some things about the leakage from time to time, I’ll will just let it leak while I am in the kayak and jump in the water more often than I normally do.”(We’d each have our own kayak if you are wondering if there was going to be an issue with fishing in the same kayak with an incontinent friend.) “Well O.K., where do you want to meet?” “You come to my office and we can go from there, and then your car will be on the way home coming back.” We go up Highway 985 north, and take Duncan Bridge Road to get to the river. I explained as we drove about how I had gone to great lengths to continue on with things without telling people about my cancer or recent surgery. He said that he had heard nothing of it. I mentioned that I felt some people at times looked at me differently, like” they knew.”  (Only on one occasion had someone asked me if it were true that I had had surgery for prostate cancer. It was a female gynecologist, and when two nurses nearby quickly looked away somewhat awkwardly, she immediately asked, “Did I say something I shouldn’t have?” There were people who did not know, and some who knew, and, although they would not tell me they knew, I could feel it. Some people began to treat me differently, a little nicer I thought, as if maybe they felt sorry for me. I began to be sensitive to the fact that if someone was acting nicer or more deferential to me, they must know. I did not want pity or whatever it was they were doing that was different than before, but I did like it, and it changed me. I began to be nicer as well, thinking I don’t want to mess up the aura of good will that is being shown to me. I remember Bill Clinton saying of George Bush that America had the good will of the world after 9/11 and we squandered it going to war with Iraq. I don’t necessarily agree with that political view, but it fit for me and it became my model; don’t do something mean as a doctor or as a person and lose this thing you have going on. There are lots of times in the course of an operation for the surgeon to be mean-spirited in his tone or actions, so I was on my guard not to be “myself.” I was inappropriate during a surgical case one time, and after I apologized to the circulating nurse she said, “That’s O.K. Dr. McHugh, we know how you are.” It was actually a learning process for me in appropriate physician social behavior, and I have retained, or at least tried to retain, some of the good habits I developed during this time.)

On the way I decided to stop at a country store to get some night crawlers. The deal on live bait is that if all else fails, it is the best thing to use to catch fish. I personally rarely use live bait, but when I take someone fishing, it is a nice fallback if no fish are being caught. We arrive at this little store that has the bait, Creekside Trading Post, which is about two miles from the river and cabin and really “off the beaten path.” Tom says, “I’ll go in with you to see what other tackle they have.” When we go in the store, I see sitting on a stool in front of the cash register a neighbor who has a cabin near mine on the river. He lives by himself, and I imagine must have an afternoon ritual of having a coke at this store and visiting with the owner. There were several other customers in the store when Tom and I entered. I had just finished up my conversation with Tom about my previously mentioned revelations and intentions about “keeping my disease quiet,” when my river neighbor sees me and yells across the expanse of the store, “Hey John, I heard you got cancer!” I turned and looked at Tom with a “Now that was funny!” look and then at my neighbor to nod.  I then shifted my attention to the guy at the cash register and asked nonchalantly, “Y’all got any night crawlers?”

After the “store” episode, I slowly began to tell people in an ever-broadening circle of who I felt should know. One particular group of the “enlightened” were my patients who had prostate cancer. For many of them, I had removed their prostate and probably seen them at a previous office visit in my urine collection “contraption” without their knowledge. I would say it took about a year and half for me to begin to more liberally tell people about my prostate cancer, and it was nice to be able to do so retrospectively. My patients that were beginning the journey themselves, I felt, seemed comforted by knowing their doctor had been through what they were going through. I think I now can sense a patient’s anxiety about a particular facet of the disease and address it much better.

My hesitancy in telling others about my prostate cancer and that I probably made a bigger deal out of it than necessary, reminds me of the time I informed my daughter about my first law suit. She was to be the Sugar Plum Fairy in our hometown’s ballet company production of the “Nutcracker” and she and her mother were looking at ballet shoes in a magazine. “Bess, I want to tell you that I will be in court all next week for a malpractice lawsuit. One of your friends at school or maybe a teacher may mention or ask you something about it, and it could be in the paper. Daddy has not done anything wrong, it isn’t like I could go to jail or anything, it is just something that happens to doctors these days, and it will be O.K.” Again, just like my aunt said of my grandfather Robert Cooper Davis, I began to feel the moistness in my eyes beginning; I hate that when it happens. Bess looks at me for a few seconds and then at her mother and says, “Mom, I think I like the pink ones better.” It was probably the best thing she could have said.