The pain of the prostate biopsy precedes itself

Did I treat you fairly?

W

hen I was a freshman at North Georgia College in the spring of 1974, I had this plastic football with a screw-off top that could hold about a quart of my favorite liquid. Other than the fact that it was plastic, one might never know its true function. As North Georgia College is a military school, it had strict rules prohibiting alcohol on campus, so my trick football was a big hit with my friends, particularly for sneaking alcohol into on-campus events. I had stolen the ball from my brother Bob. I don’t know how he got it, and I am sure he didn’t suspect me of taking it – it just “went missing.”

At that time, I loved the band Atlanta Rhythm Section, and I had my own bootleg version of one of their first albums (which I had of course stolen from Rushton, my oldest brother). My favorite song on the album was titled ‘Back up Against the Wall’. I played it over and over, knew all the words, and I would somehow find a line in the song to apply to any situation. It just so happened that the Atlanta Rhythm Section was to be playing at the North Georgia College gym that spring of 1974, so I got the ole football out and filled it with coke and Henry McKenna whisky, and went to the concert with my friends Keith Nowicki and Bart, who loved the Marines and whose goal in life was to be a Marine. We had all taken big sips from the football in the dorm before setting out on our walk to the gym. Everything at North Georgia was situated around a large circular “drill field,” so from the dorm to the gym was only about a five-minute walk. “Fill up the football, take it to the concert,” we sang on the way; passing it around both as a container and as if it were a real football. We strut into the concert with the football, everybody takes a football to concerts don’t they, and sit on the floor of the gym in the first row right in front of the stage. They did not play my favorite song ‘Back up Against the Wall’, but I remember they ended with ‘Angel’. I loved that song then, and I still do. As soon as ‘Angel’ stopped playing, the students just got up and started walking out without doing the usual chant for an encore after the last song. And then it dawned on me that throughout the entire concert no one danced or showed any emotion. Mostly they just sat, listened quietly, and then got up and left when it was over. That there was no encore performed made me furious; I just knew if they had been encouraged to play another song, it would have been ‘Back Up Against the Wall.’ That, in addition to the football elixir, prompted me to talk disparagingly about my fellow students. I made a “scene,” as my mother would say, all the way from the floor of the gym, through the lobby, and on out into the walkway leading away from the gym.

The following Monday, there is a sticker on my dorm door telling me to “report to the Commandant of Cadets, ASAP.” I read the note, and for the life of me, had no idea what this could be about. After my first class, I dutifully report to the Military Department. It was in a separate building where all the military classes were held, and all the teachers associated with Military Science had their offices there. I announce myself, and they usher me in to see the Commandant, the head guy of the military for North Georgia College.

”Sir, I am Private McHugh, Echo Company. You wanted to see me?”

“Yes,” he said. “Did you attend the concert at the gym Saturday night past?”

“Yes, Sir, I did.”

“You have been reported for Conduct Unbecoming for a Cadet. Are you aware of that?”

“No, Sir, I was not.”

“It says here you used language unbecoming of a cadet while leaving the gym that night, is that correct?”

“Yes, Sir, that is probably true.”

“What is your side of the story, Private McHugh?”

“Well, Sir, after the concert, all the students just got up and left. They did not applaud and demand an encore.” At the time, as silly as my response must have appeared to him, I truly felt that he agreed with me, and that my actions were the appropriate response to the situation.

 “Well, Mac,” the Commandant pronounced slowly and deliberately, “this type of behavior cannot be tolerated, regardless of how strongly you feel about not getting to hear the encore. I am going to have to give you some demerits and two hours of walking the drill field next Sunday afternoon.”

All in all, I thought the meeting went well; I had done what I was accused of, I got to meet the head guy, and I thought he liked me. I felt that he was probably tired of the strictly military type students, and that I was a refreshing change from the students he interacted with all day kissing his backside. I took the demerits and walked the drill field with pride.

Zoom ahead 25 years. I am now a board certified urologist, and I find myself sitting across from a portly man of about 70 who has been referred to me for an elevated PSA, which had raised concerns in his primary care doctor. I like this man on sight, and as is my usual custom, I ask him a little about himself before getting into his medical issues.  He is reading a book about some historical military event. Despite not really liking the military side of having been a cadet, I do love history, particularly military history. I have listened to the entire Shelby Foote book on the Civil War, and it is some 80 hours long. So, I ask him about the book, and he tells me he was in the military and in fact went to West Point. I had wanted to go to West Point. In fact, I had someone who could have recommended me for it, Judge Birdsong, in LaGrange, but I felt that my eyes were too bad, and I was afraid that I could not make high enough grades there to assure my getting into medical school. I also wanted to go to the Citadel, but for the same reasons, in addition to out-of-state expenses, I went to North Georgia College instead, a “poor man’s West Point.” As my conversation with my patient continues, he says, “In fact, Dr. McHugh, I was the Commandant of Cadets at North Georgia College.”

“Really? I went to North Georgia College ’73 to ’77. When were you there?”

“’71 to ’75,” he replies.

Then it dawns on me. “I think I had to come before you for Conduct Unbecoming for a Cadet, the spring of my freshman year, which would have been 1974.”

“How about that,” he says, and then quickly changes the subject back to his problem. “So what do you think about this PSA business?”

I examine his prostate and we mutually agree that a prostate biopsy is order. I remember distinctly his asking a few more questions than usual about the pain part of a biopsy. It was as if the reputation of the pain associated with the biopsy had preceded itself. He was outwardly more concerned about the potential for discomfort than the potential for the biopsy being positive for cancer.

The day arrives for the Colonel’s biopsy. I enter the ultrasound room, and my nurse and I position Colonel Terrell on his left side with the legs in a cannonball position so as to facilitate the ultrasound probe and the biopsy. I put on gloves (when you see children as patients, they start to cry when they see the doctor put gloves on), and I inform Colonel Terrell I am about to begin.

 “Dr. McHugh, before you start, may I ask you something?” he asks, putting his right arm in the air as if making a stopping motion and lifts his head to peer over his right shoulder to align his eyes with mine.

With the probe poised at the anal verge, I say, “Yes sir, what is it?”

“You mentioned on my last visit that when I was the Commandant at North Georgia, you had to report to me for bad conduct as a cadet.”

“Yes, Sir.”

“Well, before you begin, I want to know if you feel I treated you fairly?”

“Yes, sir, I do.”

After a deep and noticeable sign of relief, he said, “Okay, you may begin.”

Colonel Terrell’s biopsy came back positive for cancer; he ultimately had external beam radiation and did well from a prostate cancer perspective. Later that year, just before Christmas, he brought me a newsletter that he sent to family members and all the people he has known throughout his military career. In it he retold the story of the Commandant coming before a former cadet who is now the urologist wielding a biopsy needle, the cadet himself having come before the Commandant for disciplinary reasons years before.