A Summer Friday at the Urologist’s

It seems like all my male friends have had biopsies of the prostate, and not wanting to miss out on something special, I arranged to join the club. I picked a hot Friday in July. The forecast was 110 for Tucson, too hot to work in the yard or go birding; a perfect day to hang out at the local urology clinic.  I arrived early and had just started a Newsweek article about Obama’s first election when they called my name.  The clinic’s thermostat was set at deep space, but I broke into a shirt-staining sweat as I followed Mary to Room Number Four.  Mary smiled, told me to take off all my clothes from the waist down and lie on a cot that was covered by a large maxi-pad.

“Face the wall and assume the fetal position”, she said.

“That won’t be hard”, I answered. “I drove all the way here in the fetal position.”  She left the room, telling me they would be back in a few minutes. Time creeped, giving me second, third and fourth thoughts. Finally the door opened. Facing the wall, I couldn’t see how many of ‘they’ were there, but my doctor leaned into my vision, smiled and apologized for the delay. He looked calm and competent, experienced and kind. The look of a trained CIA professional.  He told me he would explain everything in detail as the procedure progressed, which in hindsight I should have declined.

The first step, he said, was to insert an ultrasound probe so he could ‘map’ my prostate gland.  He told me I would notice that the probe was larger than the finger he had used on an earlier digital exam. He was right. At first, I thought he had mistakenly chosen a broomstick instead of the probe, but then I realized it was probably a Louisville Slugger baseball bat, inserted from the large end. He hummed ‘Take me out to the ballgame’ while he maneuvered the probe around, seemingly mapping the southern hemisphere. I squirmed and sweat baseball-sized bullets.

Apparently this was not considered painful, since he finished mapping before injecting pain killers.  “Now I’m going to inject lidocaine into one side of your prostate”, he said. “You’ll feel a sharp stabbing pain followed by a diminishing aching pain.”  He was right. “Now we’ll repeat that on the other side of the prostate, and you’ll feel the same thing.” He was right again.

He asked someone I couldn’t see to hand him the sampling needle. “This may be a little uncomfortable, but it shouldn’t hurt much”, he said. “You’ll hear a snapping sound as I collect each tissue sample, twelve in all.”  My friends had told me this sound reminds you of a staple gun or an empty BB gun, but the needle is a 16 gauge, which suggests a shotgun. This tool is called a ‘soft tissue biopsy system’, is spring-loaded and when triggered by the doctor, fires the needle through the rectum wall and into the prostate gland to collect a tissue sample.  The needle itself is 9 centimeters long, well on its way to 4 inches. The online description features ‘one handed operation’ and ‘automatic spring-loaded for fast, accurate penetration.’ It’s a one-use device for sale at less than 500 bucks, so if you were a masochist, I guess you could try this on yourself at home. After the first fast and accurate penetration, the assistant reloads and the doctor moves to the next target area and fires again.  I lay there imagining I was at the battle of the Alamo and wishing Santa Anna would get it over.

I lost count, but the doctor told me he had decided to get 14 samples instead of 12. Afterward, he explained the post procedure instructions and what to expect, most of which had to do with blood and bleeding. One of the reasons given to call the doctor was if you experienced ‘heavy bleeding.’ Bleeding from various sources could be expected for up to months, but ‘heavy’ bleeding was cause for concern. I asked him how I would know the difference. He said when I look at the blood, if I asked myself “I wonder if that’s heavy bleeding”, it isn’t. But he said, “If you take a look and think Holy shit, that’s a LOT of blood, call the office.”