Denial is a powerful force. I learned this, in a new and special way, after volunteering for the free Prostate Cancer Screening Clinic at the hospital this Saturday. I’m a sucker for desparate pleas for help.
Somehow, I imagined that I would be seeing patients with clip-board in hand, seated pleasantly across from a patient who, dressed with full dignity, detailed to me their past medical history, urinary problems, and pertinent medication use. After this time of information gathering, I would direct the patient to the back, where the urologist would be waiting with a gloved and lubricated finger, ready to detect any concerning anomaly in this spongy, golfball-sized gland.
When I arrived early at ten of nine, however, a sense of panic slowly but steadfastly took prominence in my now frail psyche. The nurses and volunteers seemed relieved to see me. “Okay, there’s a doctor here! We can get started!” Fifty aging men milled about in the waiting area. I convinced them to wait to send the patients back until one of the urologists came (around nine o’clock), but it was soon clear to me that the urologist was here in a collegial and only occasionally consultative role. If there was something I was unsure about, I could ask for his finger’s expert advice.
So there I was on my Saturday morning, doing prostate exam after prostate exam. I think I did about forty. My typical patient interaction started with a brief pleasantry, “Hello, Mr Smith, I’m Dr. _____; how are you this morning?” And continued with my reviewing the survey they’d already filled out: “I see you have some trouble getting up at night to urinate, and often have difficulty starting your stream of urine. Let’s see, your last prostate exam was three years ago? And it was normal at the time?” And then came the meat of the encounter: “I’m going to have you lower your pants, and simply lean over this gurney. Do your best to relax…and…a little pressure…okay, done. You can get dressed.”
Sometimes there were amusing variations in the conversation. Such as when several patients asked, “Do I need to lower my underwear too?” Or another patient who looked at the cart with gauze, lubricant, gloves, etc, and asked, “So is that all the free stuff?” I said, “I’m sorry sir?” “Are those things free?” he replied, “How ’bout those socks?” indicating the brown socks that were handed out to the G.I. inpatients, as the clinic was held in G.I. endoscopy lab prep/recovery area. “I’m sorry, this isn’t an airplane. Go ahead and lower your pants,” was my reply.
I guess it was nice to do a community service, and I think there may be a $50 honorarium involved! I definitely feel more comfortable with my prostate exam. But most significant was the experience of finding a nodule, as I found on three patients. Even though it’s bad news to tell a patient, referring them for biopsy means they have a chance of catching a potential cancer while it’s easily treatable with surgery. It was a chance to make a big difference in those patients’ lives!