There is a line in Godfather III that keeps running through my head. Michael Corleone is speaking with his sister Connie, and he says, “Just when I thought I was out, they pull me back in.” That is, alas, for me the story of late July and early August.
As you may remember, on 25 June, I went under the knife to have my prostate taken out at the National Institutes of Health (NIH) in Bethesda, Maryland. That operation went smoothly, and there were no immediate complications – no infection, in particular. The initial post-operative period was a bit grim, but I made steady progress and went home on 3 July. Soon thereafter, I learned that the cancer had not spread beyond the prostate and that I appeared to be cancer-free. All that was required for me to be fully back on my feet was caution and patience. So I believed.
But I was wrong. In the afternoon, when I walked or sat – especially, when I leaned or twisted to the left – I experienced pain. Low-level pain, mind you. For a long time, I assumed that this was normal post-operative pain associated with the seven incisions made for the robots used in my operation.
On 22 July, however, it became clear that something was seriously amiss. I popped out our front door, down the stairs, and tried to slide into the driver’s seat in my 1991 Toyota Corolla. All went well until I moved to lift my left leg over the sill and into the car. Then, I felt excruciating pain in my lower left back. Getting out was easier; getting back in was once again harrowing.
The next morning I spoke with the urology fellow on call at NIH and reported my experience. He doubted that it had to do with the operation. It seemed to him, as it seemed to me, to be an extreme case of tendonitis (which, in a sense, it was). That morning I was pain-free; that afternoon I once again slipped into the driver’s seat of the car, and the pain was once again excruciating. So I called again to report my experience and eventually spoke to a senior physician who urged me to jump on a plane, which I did on Wednesday, 24 July. The rest is a bit of a blur. I had test after test, and the ultrasound showed and the Cat-Scan confirmed that a considerable body of fluid was concentrated in the cavity between my left kidney and my lower back, pressing on the muscles there.
On the Friday, the 27th, Intervention Radiology gave me a bit of lidocaine (a cousin of novocaine). I refused the sedative offered, and the gentlemen in charge expertly snaked a catheter through my skin and down along a natural channel into the cavity. I felt pressure but no pain. That day they took out a liter of what turned out to be lymphomatic fluid. Put simply, after the prostatectomy, the lymph nodes not taken out were bleeding fluids, and instead of finding its way to the diverse collection of liquids swishing around about the intestines it collected in this particular cavity. On subsequent days, more fluid came out. Ordinarily, in these cases, it eventually stops, and the cavity dries up. In my case, the out-take from the catheter in my side declined, then proceeded at a steady, if moderate, pace.
In the meantime, something else presented itself. I came down with pneumonia. When that happens in a hospital, people get very, very nervous. If it is “hospital” pneumonia, as opposed to “community” pneumonia, it can be resistant to antibiotics. I was put on an IV and fed a heavy dose of Zosyn, Arithromyecin, and an antibiotic whose name I never heard – while Infectious Diseases here at NIH studied my sputum and tried to grow something from it.
In the meantime, it became hard to find the veins on my arms and hands. Usually, I am an easy stick, and usually I feel little pain. Not this week. Moreover, if the IV feed was temporarily stopped, the vein in which the needle sat tended to collapse. One evening two nurses tried to draw blood and failed; another evening, three did so. I grew impatient (which is not what a patient is supposed to do). The pneumonia knocked me sideways. Lots of coughing, high fever (102/3), and chills, and the coughing rendered endemic the incontinence incident to prostatectomy. To put it bluntly, I could hold my water if I did not cough. But this week I did little but cough. I used to laugh at the thought of old folks wearing diapers. Now, at least for the time being, I am one of them.
In time the, antibiotics brought down my white blood counts from 15 to 6 and my temperature to something like normal. In time, the sputum culture indicated that my pneumonia was a run-of-the-mill sort, and I was taken off the IV and given amoxycylin. And today, liberated from the IV, I managed to shower for the first time in five days (a consummation devoutly to be wished). But now I face another dilemma.
The fluid in the cavity is not drying up. Something more radical needs to be done or I will be back in the same pickle in which I started. The cavity in which the fluid collects must either be closed so that the fluid cannot enter. Or it must be opened where it is now closed – so that the fluid that enters it gets dumped in the perineum and joins the waters about my intestines. The former can be attempted by running alcohol down the catheter into the cavity, but on average it takes twenty to thirty days of repeated experiments, and it cannot be done in Hillsdale where I live. The latter is quick and easy but requires laproscopic surgery, which involves anesthesia and brings with it all of the ordinary risks of surgery.
We seem to be about to try the former. My suspicion – horribile dictu! – is that the latter will soon be necessary. Having had a prostatectomy can be a bit like being married. It is not a state to be entered into lightly -- for, if things go bad, just when you think you are out, they pull you back in.