Pronouns: Why so difficult for older people? One person's answer

We hear you when you say my pronouns are . . . Some of us even recognize the freedom that you feel that you are getting in choosing your own. Some of us (many?) have wrestled with the same issues. So why do you get so much push back? It is really quite simple. After years of playing mind games with the little M F boxes on so many forms we have just given up and decided to go with the flow.

As a young teen I may have resented the changes occurring in my body. I was embarrassed and a little confused. I even thought that everyone else knew that I was not the gender that I was "supposed" to be. Walking I would ask myself, was my butt swaying and giving me away? Did I really feel like a "guy"? How was that supposed to be? What if I really was a woman? 

Then came Christine Jorgensen and the world changed. It was possible to change. That dream that I had of riding an escalator and arriving as a girl in the women's department of Kaufman's department store. That was a dream that fueled years of hope and anxiety. How does one change overnight? What do you tell your friends? Oh how deliciously wonderful and scary.

Premarital counseling brought out an odd fact that totally freaked out my fiancée . I scored higher on a feminine scale than she did. Then she noticed I liked my nails just a little longer than she thought were right for a man. She saw how I used my fingers, how despite their size they were the most obvious feminine part of me and as such something that was very dear and special. I did I hated the feel when they were trimmed back, it wasn't right. We did not last as a couple and I am pretty sure her eventual husband was a man's man who knew how to trim nails and didn't help out in the kitchen after meals with the relatives. (watch football? really?)

Meanwhile back in reality the boxes are still there to check. Years of wondering, experimenting, investigating. The Internet, actually something called the Usenet, beckoned. Suddenly there is private, anonymous contact with others. Of course some of those others were trolls, but some were not! How wonderful to be able to discuss those feelings, to explore the possibilities. Discovering that you actually know someone who had fully transitioned from Male to Female, but by then approaching 50 still wondering about those boxes but so used to clicking on the one assigned at birth. Then there is the realization that though my friend had made the transition, could I? Was the world ready for another 200 pound drag queen? My body ravaged by years of testosterone abuse was not such a pretty sight. The woman I knew would never be. 

Funny thing is that the boxes have ceased to be anything but a cause for reflection. Yes, it would have been nice to have acted on those feelings as a teenager, but as a 60-70 year old the memories of what could have been are sufficient. Life is too wonderful to have regrets and we have grown accustomed to our assigned life. Maybe next time God will get it right. And then the youth start with the questions, the demands to change and the age old dilemma of those who have been there and settled. You are upsetting our deal with ourselves. You are calling into question the decisions that we made based on the opportunities and options that we perceived in the past. And damn it you are calling on us to question ourselves. It is easier for many to act as if you are wrong than they. Forgive the gender distressed old people, you have put us back in high school, a place we never wanted to be.

In case you know me and didn't know

 It isn't personal. There is nothing to tell you right now. When and if the cancer spreads and I actually need treatment, you will know and if you are family you will know first. For now, No one reads this anyway :) fo you may still be the first to know!

Read the Doctor's Notes

 

I just took a few minutes to review my doctor’s notes in MyChart (online med records) Did she really say all of that? Honestly? My recollection of the discussion really boils down to “Cancer . . . cancer. You’ll be OK. Any questions? Great I’ll see you in 6 months.” When I read the notes I see all of these descriptions of treatments with side effects and so forth. Having read a lot on line already none of that seems new or strange, but did she really say that? Did I really hear it?

I am certain that there were two different experiences going on. One the professional who has memorized all of the required discussion material and gets it out as fast and fully as possible and then there is the patient who sits like a deer in the headlights. A third party might see the two operating without knowledge of the other, or they may see two individuals interacting appropriately. It doesn’t matter. I know she went over stuff and I know that I did not hear her nearly as well as she or I thought. So read the notes, be sure that you understand what the treatment options are and what the recommended plan is and then follow it.

How hard could that be? We as humans are capable of knowing and ignoring facts at the same time. I was working in a hospital ICU once when I heard a family member, a para medic at that, describing his wife's condition over the phone. I knew the situation and was impressed with his clinical and accurate description of the extremely critical condition. When he was through he assured the listener that "She's fighter, she's going to get better." All I could think was, did he not just describe a quadriplegic? How is she getting better? He knew her condition but he didn't comprehend her condition. Listen to the doctor, but allow the information to process, check it against some reality.

Dumb Luck is better than no luck at all

 So how did I get to a point that I was diagnosed with Prostate Cancer? There are damn few signs and those that are there aren't readily observed by the patient. It turns out that I was getting dissatisfied with the trends of BPH weak urine stream, going more often than I felt I should. Hardly a big deal in the scope of things but bothersome and it being winter in times of COVID-19 I probably could add general boredom and looking for an excuse to get out of the house. At any rate that is what put me in the office that day and why my doctor was giving me a little bit of "just why are you here today" when we got to the Digital Exam and her demeaner suddenly changed from he's and old guy who needs attention to OMG this is not a drill.

What I am trying to say is that regular checks are important. I had gotten a yearly health check as Medicare calls it just a month before and for whatever reason did not have the DRE. Why I do not know and I am certainly going to inquire. What I will say to anyone reading this is ASK FOR IT. Better a few moments of discomfort for early detection than finding out too late. 

A female doctor for a male problem? Really?

 So by now you may realize that my urologist is a female. Why would I seek out a female doctor for a problem that she cannot understand first hand? The answer is, for me at least, quite simple. It has to do with the most important test that a Urologist can do, the Digital Rectal Exam. I have had male and female doctors and have had this exam from both. I can say without fear of contradiction that the experience with females was heads and shoulders above that with the males. Why? Male doctors whether consciously or not tend to be rather insensitive to patient comfort. I suspect it has something to do with homophobic behavior as often I have heard from my male doctors how much they do not enjoy the procedure either, like that should even matter. I do not care if you enjoy the procedure. Just get it done quickly and efficiently and if possible do not cause too much pain.

Female doctors on the other hand tend to have more slender fingers in the first place but do not make excuses for the process. They get in move the finger over the prostate and finish up. The thing that matters is that the doctor feel the area for bumps, that my comfort is considered is a plus so my preferred doctor is tall thin with piano player hands - oh and yes, intelligence and wit. I think I have found such and I am going to stick with her. I did have a second opinion when she wanted to perform a TURP for my enlarged prostate a few years ago, got the opinion which was a concurrence and went straight back to her to schedule. Not looking back.

Now I know that the argument for a male doctor is that they can experience the same thing and should have a better awareness of what I am going through, but the the evidence to date points out that their similar anatomy is not enough to make a better result. It doesn't matter that they should respond to the procedure the same way I do it the female doctor is better at it in the first place. Add to that that female doctors seem more caring and are over all more gentle and there is no doubt if I seek another surgeon down the road she will be female.

At some point I may share just how wicked a sense of humor my doctor has, but for now I think I will keep that between the two of us.

How is this so not a thing and yet a huge thing?

According to a leading urologist in his book, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer:

    Prostate cancer is the most common major cancer in men and the third-leading cause of cancer 

    death in men. . . .when prostate cancer is small and curable . . . If it's     caught too late, prostate 

    cancer can be deadly, and if the disease is allowed to run its course, it can produce terrible 

    symptoms and excruciating pain. But if caught in time,  . . . prostate cancer can be cured with 

    surgery or radiation.  For some men with small, slow growing tumors, a process called active                    surveillance -- following the disease closely--may be a safe option.

Translated into my brain this says, "Prostate cancer is deadly, but can be cured if caught early, but if we catch it early then we will just sit back and watch it grow."  So why not just kick it in the ass on day one? Seems like a no brainer, until of course you look at the side effects of the cure and realize that peeing may never be the same and though sex may be possible it is not guaranteed. So we wait until the ugliness of the cure is less ugly than the disease. I think I now know why I didn't sleep well last night!

This is exactly the same kind of double speak from the medical community that we are getting on the Covid 19 vaccine. Take the vaccine or you will get the disease, but if you take the vaccine please don't change your habits, stay home, mask up and social distance. They are then surprised when people say "Why should I, I still have do the drill? Where is the upside?" The upside is, of course, that you are less likely to die if you take the shot. The upside with prostate cancer cures is similar, the cure isn't fun but you won't die. Makes you want to go dancing doesn't it?

Cancer, me now and for the foreseeable future

 Feb. 24. 2021

I am officially a person living with cancer, specifically Prostate Cancer. I have been official for a little over a day now although I have “known” since Jan. 26^th when at the end of a consult with my urologist it became time for the Digital Rectal Exam. It had been a normal conference, 3 years since my TURP and I had started having some symptoms of BPH that were starting to be annoying. Our discussion had been normal to that point so I thought nothing when I dropped my pants and leaned over the exam table. “A little coolness and then a poke” she said before the familiar feelings of pressure and general discomfort. “hmm” I heard as she concluded the exam. I pulled up my pants and turned around. The smiling eyes were gone, a serious stare was forming as we sat down and she said, “I felt a hard spot, a nodule that wasn’t there before.” From there it was an explanation of nodules and bumps and ultrasound and needle biopsies and assurances that even if this is a cancer everything will be all right.

We scheduled the biopsy and I got a PSA. The PSA was 3.2. That is still in the normal range so I asked in a note “Do I still need the biopsy?” I knew the answer before it came back, “I know what I felt. We need to do this.” So a few days later it was twelve hits with the needle gun (sounds a lot like a staple gun not painful but the sound is unnerving.) I assured her that I wanted the results in my MyChart account as soon as they came in, but I already knew. She already knew, we knew when she felt the bump. The difference was that it was not official, I did not “have” cancer, at least I did not have a diagnosis.

That all changed at 9:52pm on the 22^nd of Feb. when the email came in stating that I had results in my record. The fourth of six paragraphs began
                4. Prostate, right base, core biopsy:
                    Prostatic adenocarcinoma, Gleason score 3+3=6/10 (Grade Group I),
                    involving one of two cores (15% - 2 mm).

It was real. I would read on to find that I had cancer findings in 3 of the 12 samples. I was now a person with cancer. I now had a Gleason score, the number assigned to tell how advanced your prostate cancer has become. Mine was Gleason score 3+3=6/10 for all three cancerous samples.  It was 10 o’clock at night and my wife was almost asleep, I made the decision to wait till morning to share the news. By 8 o’clock on the 23^rd I had an appointment for the pathology discussion and my wife and I would be there together. It was surprisingly simple. I had read a lot online in the weeks since the DRE so the words the doctor was saying were largely what I had already known. Slow growing and best thing for us right now is to watch and wait.  And so it begins.

The funny thing is I don’t feel any different though it did feel weird to read a note from the doctor today noting, “your disease . . .” My disease, like a possession, but one that you can’t lose, one that actually possesses you. I am now defined by my symptoms, by my errant cells. I am a person living with cancer.

Next: How is this so not a thing and yet a huge thing?