The Vengeful Prostate

The Melba Notebooks, Chapter IX *

When Bob was found to have prostate cancer at age 83, his doctors insisted on surgery in view of his physical and mental health. After all, he usually rode his clunky old bike 8 miles each way to doctor visits.  Despite efforts to convince Bob and his doctors that surgery at his age would be to sacrifice quality of life for surgical complications and some dubiously good extra years of very old age, the surgery was done. He recovered  beautifully, but has always since hated surgeons for the incontinence and impotence they gave him; he remembers with some bitterness that  his father had  silent  cancer of the  prostate for 15 years, dying of a stroke at age 94.  The surgeon notes  grandly that he saved Bob’s life.

During five  long years after his prostatectomy, Bob fought to control his urinary incontinence through strengthening the voluntary muscles that may help to control urine. There was not the slightest improvement, despite dogged and focused exercises done many times each day. He read and researched diligently, and at last discovered Dr. Stamey, the urologist at Stanford who pioneered an experimental procedure to control incontinence in men caused by prostate surgery. They spoke; and Bob decided to visit.  No one else was aware of the planned consultation until the following note from Bob appeared in the notebooks, written just after he called to ask me to accompany him.

11/19/97 Bob: I’ll be with Ja  tomorrow night then at Stanford in Palo Alto Fri & Sat on.  His tel is — —-Believe his wife and youngest daughter will be there over the weekend.

Not only does Dad almost never make notebook entries, but I never recall him leaving detailed instructions to Melba when he leaves on a trip for a month or two at some remote mine. He expects her to act independently, and within the confines of their unspoken understanding.  Now, however,  there are  quite detailed instructions for “Melba’s Handmaidens”, a derogatory term he has given to Di and Li. Here is the instruction sheet set forth an  engineer’s  regular and tightly penned  hand,  reflecting both an attention to duty and a solicitous and almost  tender  concern for the  good woman who has been his loyal companion for almost 70 year; the list pretty accurately reflects what he doe daily.

(Phone numbers) Di; D, school

To be done daily  Di, S, D:

At 6 or 7 AM turn thermostat up to 70 or 71.

Give Fosamax.  She should stay up and wait half an hour before eating breakfast.

Make fire in wood stove prepare oatmeal, granola or eggs for breakfast and bring to dining room table wi napkin, Silver, water, pills ( need pills for Thurs Fri Sat Sun) & cup of coffee wi milk.

Cleanup and wash dishes.

Bring newspaper from front porch or from white plastic holder below the mail boxes.

Empty waste baskets as needed-much to wood stove.

Wash floors of easily seen litter.

Take out any garbage, tin cans, glass, and aluminum to lean-to on South side of garage,(small door).

Bring in any wood needed.

At 12 or 12:30 Get mail from white box on far side of the road

Sort mail and pass hers to Melba.

Mail any letters & get groceries in town as needed.

Heat and serve supper in dining room, keeping a little fire in wood stove, if needed.

Clean up & wash dishes

At 10 or 11 Turn thermostat down to 60

After a wash fold and stow clothes, table cloths, towels, sheets, bedding, and pillow cases.

11/20/97 Di: 10:00 AM Di: Cam(e)  to take Melba for hair app.  Why Dad wanted her to go there I really don’t know.  Took her & came back to do up laundry dad wants to take with him. S will take dad to the airport.  (Mom is a little sad because she’s not going.

10:00 AM Di: Came  to take Melba for hair app.  Why Dad wanted her to go there I really don’t know.  Took her & came back to do up laundry dad wants to take with him. S took dad to the airport.  (Mom is a little sad because she’s not going.

5 PM: Mom  still  @ S’s when I got here.  They came about 6 PM.  Now Mom and cat watching TV.  Doesn’t want any dinner. S said she’s eaten good today.  But I will try to get her to eat something later.

I  take Bob to Stanford on Friday. The schedule is tight:  Evaluate him that day, decide if surgery is a good option, and if so, stay there so surgery can be done Monday.  The operation is daunting: An incision is made low on the abdomen, just above the pubis.  Two long needles interconnected by wires like those huge sweater knitting needles are used. The first needle is thrust through the incision and the body front to back and out through the skin   between the scrotum and the anus.  There a second incision is made; bolsters are threaded over the needle onto the wire.  Then the other needle is thrust back up to the original supra pubic incision. The two wire ends are tied over another bolster, to form a sling that compresses the urethra. The sling is tightened just enough to compress the urethra, but allow urine to pass with the increased pressure of straining. Three such slings are placed, and the incisions closed over the bolsters and wires. Ouch! A suprapubic catheter is left in place to allow for urine drainage until the swelling around the urethra clears up enough to allow urination. In the meantime Notebook entries continue:

11/21/1997 Di: Last night went OK.  Melba went upstairs to bed about 8:15.  I went up this morning to check on her again she was sleeping but woke up when I closed the sliding door.  S is to be here this morning so I can head home & start my cleaning clients.  I’ll be back tomorrow Nite about 5 PM.

The Dr. is a friendly, warm, avuncular man who has just “retired” from the department of Urology. He must decide whether the operation is actually indicated. For the next hour I benignly observe a  urometric exam which is, in the vernacular, awesome, only partly because it is done by three attractive 20 something female technicians. (No wonder the retired Dr. is still at work!)  They measure every aspect of the function of the bladder and urethra. The results indicate Bob leaks like a horse with any cough or strain.     At the outset Stamey had discouraged Bob from the operation. But after a thorough history and physical exam, he changes his mind.  Not only is Bob terribly incontinent, but he is physiologically 20 years younger than his age. A concern is that his heart rate is about 50, but after a long session of tests and palaver the  cardiologists find the rate   is related to uncommonly good athletic conditioning.

Only about 100 of these procedures had been done by Stamey and a disciple of his with ‘90% ‘success’. The question, of course, is how success is defined.  But Bob  mind is made up. He refuses to ask further or to  hesitate after warring with the problem alone for  those long years of incontinence. The Dr. expects him to be in the hospital for a few days, and to stay in the area for a week for re checks. No one is  aware Bob has his return airline ticket in hand.

11/21/ 1997 Di: Mom slept in till 8:45 guess she had a big day with S.  I  go do my other clients.  Got back at 4 PM just as So & Mom were leaving will to go for ride, so I started cleaning out cupboards & draws. I sure hope Dad isn’t mad when he sees it.  I threw away everything that was open & that I haven’t bought in the last two years.    Alot of things had bugs & raisins had worms.  Mom fell asleep in chair watching TV. So helped her up to bed about 9:45 PM. Everything quiet here.

11/23/ 1997 Sophie:  Sunday 11:00 PM  Mom fine at our house until 8:30 PM when she wanted to go Home to bed.  Would not stay again overnight.  Was very happy to go up to bed.  She thinks she ought to go see how dad is doing in California- waits for him to  call.  Forgets he is having surgery on Monday rather than today. Looks like he will have the operation:

Fri Tests done.

Sat/Sun hotel

Mon    Surgery

Tue   Wed     hospital

Thur Fri  Sat  Sun  hotel.

Mom is so glad to be back in her home after being gone daytimes. She will

not stay away at night

PM  Sophie: Mom  forgetting where Bob is, and when she does remember, or is reminded, fretting about not being with him, and about missing a chance to visit her long lost and long  remembered Durham Ranch.

Surgery goes very well, and after a couple of days Bob leaves the hospital and stays with his nearby granddaughter.   After his first post-op check-up he flies home as he had hoped.  Yet the surgery is far more uncomfortable, with far slower recovery than was the radical prostatectomy.

11/24/ 1997 Di: Mom slept in till 9 AM again today.  We had breakfast & talked about Dad. She can’t understand why no one will call & tell her anything.  I went to store For groc mom didn’t want to go.  Got back she was eating fruit & toast for Lunch gave her a bananna. Dad called at 2:35 to tell her how things were Going.  She also talked to Ja.  I think she feels a little better.  S & Wi stopped by. Mom watched TV until about 10 PM then went to bed.

11/25,/1997 10 AM Di: Slept in again.  Had breakfast & talked about Dad’s operation.  Went in to read paper.  I got beds changed .  Had lunch, went for little ride. Mom watching movie.  Got dinner. D called to let us know she’s  home .

11’26/1997 Di: Up early- Melba up about 9:00 AM.  I heard her get up several times in the night but she says no problems.  She ate a fried egg, soft toast & coffee & juice. We cleaned stove innards (a bit sticky from Applesauce); fridge & all 3 freezers-whew!  Melba & I left about 12:30-to do some errands.  I’ll bring her back around 3 PM.  She’ll be OK here, Di. She’ll enjoy the rest.  Ja called to report that Bob is doing well.  May fly home early.

Mail is on dryer. Lunch (2:30) pasta & peas, jello dessert & salad. Water & coffee. Freshened up 2:50-watching TV. See you tomorrow.

11:00AM Mom watching TV with eyes closed. Got things  put away. Started wash- Things ready for dinner. Went to get mail. Had dinner & talked. Everything about the same.  She went up stairs about 9PM. Ja’s phone message said Dad slept all AM.  Ja made a reservation for Thursday instead of Friday.  Arriving at 1:00 airport. . He has very clear written instructions. He will be fine. In about 10 days (August 15) he can urinate .  He will measure & when he gets to less than 60 mm (ml?)  he can go to Dr H to take out the… tube thing.  NO BIKE RIDING!

1:45…running late as usual.  Mom watching TV-feels very upset about “not Knowing what ‘s happening to Dad”  Says “no one has called her.” I tried to get her to go out with me to the Library but she wouldn’t budge.

Mom says she feels like a “fifth wheel” that doesn’t feel very good. She doesn’t want to call & see how Dad is- She wants him to call her- I’m going to bed-  Bye Bye.

Di: I’m back.  Talked (phone) with Dad & how nice it will be to have him home.  Mom ate a good breakfast & is watching TV & reading the paper. Doesn’t want to call Dad. Said she would see him tomorrow. He got here late today, no problem  I guess.

11/28/1997 Di Dad went out to mow lawn can’t get mower started.

He’s picking apples. Oh Boy

Bob is dry; most of his urine output is trough a tube from his bladder into a plastic bag.  What he does void normally takes many minutes because of the thin stream.  (That later justifies his decision to use the sink in the bathroom!)  There is also a  second temporary suprapubic (thrugh the skin) catheter.   The catheter begins to leak; But  loses the plastic cap and carves a wooden replacement, which is deficient. His local doctor can’t bring himself to remove the normal penile  catheter at 10 days as instructed, so Bob does so. His Dr still fears Bob will remain obstructed if he removes the catheter. So Bob removes it himself. The urinary stream then becomes very thin.  Even years later Bob will have to strain hard to get urine past the  static artificial sphincter; he will suffer slowly progressive obstructive uremia, with urinary infections at times, including the last one, where the urine infection leads to sepsis.   But for now, gradually, things get back to “normal”, with no ambient ammonia, and most urine being drained by the suprapubic catheter.  Out there in the back lot, the ever dangerous Apple tree ends  its  annual assaultbut there are boxes of ripe fruit patiently, if pungently waiting to be canned.!

12/14/97 Sophie: Sunday. Dad cut finger on lawn mower yesterday. There is blood everywhere as he has been going along as usual with a plastic bag on finger.  To walk-in clinic.

12/17/97 Di: Mom watching TV (not dressed 3 PM) dad getting ready to go somewhere (He’s late so took car.  Look out everyone)  Did up 3 loads laundry Someone wet bed again.  Dad had quilt & a few things hanging out side in pouring down rain. 5 more pairs of his pants in wash since Monday. Mom got dressed at 4:30.  Why?

12/18/97 Di: Dad went over to church to do his thing.  W.Ps’ (wet pants) We still have a problem.

12/19/97 Di: Mom out to go to quilt show- then picnic- Dad had too much work…Has to be at sink peeling apples.

Di: PM Things about the same Dad very short with Mom. Change bed again. Fixed left overs for dinner feed cat tried to find big bowl from back porch for dad. Can’t find it.

12/20/1997 Di: Pans all over for more applesauce. Pot on stove has been there since Monday (maybe the week end)

PM Dot: 5:30 Melba at dentist today.  Here for visit & bills. Ordered new checks from  Bank; Paid Di. Out to supper at 6 PM  home at 7:30- Dad ate two dinners his & ours.  Then Dad took his own catheter out this morning!.  No mention of any problems.  Yummy dinner!  Catheter out- So far, so good.

The suprapubic catheter will be removed by Bob at  about 8 weeks post op, when it was supposed to come out in 10 days or so. At any rate, it appears that no harm is  being done  in the meanwhile despite the increased risk of infection.  The relief that comes with the absence of ambient ammonia is palpable, promising a blessed Christmas.

* Five spiral bound Melba Notebooks, dated from 1995 to 2002, contain the  hand written entries of numerous caregivers and family who make it possible for this couple, whose lives spanned the entire last century, to live in their home until their ashes are scattered in places meaningful to them. The notebook entries were the way caregivers communicated with one another, not only to avoid nursing home care as long as possible, but to shelter Melba from the idiosyncrasies of her difficult but admirable and beloved husband.  This scene is adapted from one of the hundreds of episodes recorded therein.  Names and places are altered, but the voices are genuine. Italics are the author’s comments.