The Lead Cylinder and the Plastic Urine Sieve

In 2015 (26.3.15) I went to Dr M for a check-up. After shafting me with a gloved and lubricated forefinger she told me my prostate was hard and enlarged, and recommended I have a blood test. I complied and my PSA (Prostate Specific Antigen) count was 5.4. She suggested I see a urologist in Hermanus. This I eventually did on the 4^th of August.

Dr J was a short man in his late thirties. Slight of build and fit looking, he was economical with his words and reluctant to explain anything more than once. His hands were small and soft. He used them to bend my penis in different directions, to pull down its foreskin and to palpate my testicles. This was before getting me to lie on my side with knees drawn up and giving my prostate a digital once-over. I also had to pee into a large paper cone held at an adjustable height by a contraption that measured volume and strength of urine flow.

Back on the bench he smeared cold gel on my lower abdomen and slowly slid about with a hand-held ultrasound sensor while looking at his laptop. I had a capacious bladder, he told me, and it was nowhere near empty.

Across his office desk he gave his diagnosis. My prostate was enlarged and might or might not be cancerous. It was probably not, but only a biopsy could determine this. It would also be wise to perform a resection, which entailed reducing the size of the prostate by cauterization.

A few weeks later in August 2015 K took me into Hermanus to the Mediclinic. I checked in at Reception at 6a.m. and we went up to the ward. I had my own east-facing room overlooking Westcliff. K stayed with me while I changed into my newly acquired pyjamas and dressing gown and she helped with the filling in of forms and questionnaires. The sun had come up by the time she left.

A nurse told me to change into theatre gown and underpants and to get into bed. Blood pressure, pulse and temperature readings were taken and I was given an ECG. J called in briefly, and the Sister told me later that his father had died in the night. This information made me more apprehensive, as I thought his emotional state might impair his surgical ability. A female anaesthetist was next. She asked me questions and sketched what would happen when I was wheeled into theatre. The Sister later told me that this anaesthetist was J’s wife.

After a while a male and a female nurse came to fetch me and I was trundled at considerable speed down a long corridor, through two sets of swing doors and into the pre-op area, which was also the post-op recovery room. Presently a sister in theatre garb welcomed me and ascertained that I was who I was and not somebody else and the anaesthetist appeared. She found a suitable vein in my left arm, inserted a needle and taped it in position ready to receive the drugs that would put me under. Ten minutes later they wheeled me into the theatre and told me to move across from the bed onto the operating table. I noticed an apparatus with stirrups that reminded me of gynaecological equipment and hoped they didn’t mistakenly try giving me a hysterectomy.

As a pleasant drowsiness began to blur my senses, a mask was placed over my nose and mouth and I was told to breathe deeply. The transition from here to nowhere was so instantaneous it left no memory of an experience. On returning to the surface, I found myself back in bed in the recovery room with a nurse talking to me. I felt warm and free of pain. It had been an interesting episode and could even be regarded as enjoyable. I was particularly impressed by the suddenness of losing consciousness and by the total lack of content regarding where I had been while anaesthetized. Optimistically, I imagined this was what death would be like. One would depart to a realm of complete oblivion.

On returning to the ward, it seemed as if my senses were back to normal and I was aware that I was connected to a drip and that a catheter tube was taped to my thigh. Nurses came and went, observing my condition with half-hourly blood pressure, temperature and pulse checks. They also kept an eye on the two bags suspended from a drip stand. The smaller one contained antibiotics and analgesics, while the larger one held water. When I leaned over the side of the bed, I was shocked to see that the catheter bag was already half full, and the contents were stained a dark pink. For the next 48 hours my urinary tract was to be flushed through to prevent clotting in the prostate.

They brought me tea and a sandwich and after about an hour I got up and stood beside the bed. A sister gave me permission to walk up and down. With my new blue dressing gown draped about me I slowly pushed the drip stand with my left hand and carried the catheter bag in my right. As I made my way down the long corridor, I passed art works on the walls. They all shared the same theme, depicting horizons and skies at sunrise or sunset. I took a slow drive up and down and returned to the ward. After an hour or so I went for another jol along Sunset Boulevard. Two women in white coats approached and as they passed gave me a haranguing.

“Lower the bag! Lower the bag!”

“Lower it! It’s going back into you!”

Yes, I should have set out with an empty bag and held it below bladder height, but why the anger? They must have been offended by the spectacle of this obscene old man carrying a bag of bloody piss that was being filled to capacity through a naked tube protruding from its loathsome source.

I spent three days and three nights in the Hermanus MediClinic. The pink liquid in the bag gradually turned to a paler hue and in the late afternoon of the third day J said the drip and catheter could be removed and, if I could pass urine without difficulty in the morning I could go.

That evening I experienced a paranoid panic attack that raised my blood pressure. If J didn’t release me in the morning I was going to discharge myself.

After taking a shower and pissing in the toilet I phoned K. She arrived just before midday, I checked out, and we headed home after collecting pain-killers and a box of Movicol sachets from the dispensary. I never needed the Synaleve but I took the laxative morning and evening for a month in order to keep the contents of my bowels hydrated and soft. Straining at stool is strictly forbidden after prostate resection.

I wasn’t in pain but there was a feeling of internal tenderness and a slight burning sensation on passing pale pink urine.

Two days after leaving the MediClinic following the resection there was a call from J’s rooms to say that my urologist wanted to see me. He had asserted that it was unlikely that my prostate was cancerous, but only the biopsy could confirm this. The trepidation I felt on the way into Hermanus the next day was warranted. J informed me that the biopsy revealed early signs of carcinoma on both sides of the prostate. I could either have the gland removed entirely, or undergo radiation treatment. The latter was called brachytherapy and entailed the implanting of fifty to sixty radioactive seeds that would kill the cancer cells. It was my choice but I got the impression he favoured brachytherapy.

“And if I do nothing?”

“You will still be alive in five years’ time.”

So, I had cancer. It was a bit of a shock and took some getting used to. I even thought about ways to commit suicide before the quality of life deteriorated too far. Gassing myself in the garage would probably be the most practical.

K surprised me with her tears. She said she felt so guilty. All she could think of was how alone she would be. I tried to comfort her by saying there was nothing wrong with these feelings. If the cancer spread and I was to die in the next year or two it wouldn’t be me having to cope with grief and loneliness. How many times had we spoken about our tenuous hold on life, and how it was just a matter of luck one of us hadn’t kicked the bucket already? This should serve to remind us of our mortality and I quoted Henry Fuckit: ‘You never know what’s lurking in the bloodstream, or squatting in the liver, or skulking under the foreskin, or flitting hither and thither from branch to branch in the bronchial forest.’ Now I could add ‘or crouching in the prostate.’

For the next two or three weeks I experienced discomfort rather than pain. It wasn’t long before I was going through the night without having to get up to the toilet. It wasn’t long before my urine was back to normal straw-coloured liquid, but I did experience a scare on one occasion when taking a leak out in the garden. To my horror I found that I was pissing blood and not urine. The sight of that dark red liquid issuing from my cock was so shocking I thought I was going to have a panic attack. J had warned that this might happen if there was a minor bleed, and I shouldn’t be concerned unless it persisted. The next time I relieved myself I was overjoyed to see a stream of pink that soon changed to clear water tinged with a beautiful hue of pale yellow.

I decided to opt for brachytherapy and a date was set: 19 February 2016. This would give the oncologist time to order the radioactive material from the UK. Before undergoing the procedures, though, it was advisable to check the status of my bladder by means of a urodynamic test.

K’s Hospital Plan covered the biopsy, resection and radiation but not the test, which cost over R5000. I presented myself at J’s rooms on a Friday afternoon at the beginning of October while he was in theatre and was introduced to the medical technician. I had been hoping for a grey-haired woman whose lumpy shape would be no incentive for speculation about what was inside the white uniform. Instead, I was dismayed to find myself in the presence of a female in her late thirties wearing jeans and a white cotton blouse beneath a maroon velveteen waistcoat. Her long black hair was swept back and held in place by a silver comb. She was small and slim and although not voluptuous, definitely attractive enough to cause both of us some embarrassment.

Her paraphernalia had been set up in the surgery and consisted of two monitors connected to electronic equipment stacked in tiers on a trolley. There was an office chair on castors, a commode and a drip stand.

First, she explained the procedure so that I knew what to expect. She was going to catheterise me and insert a pressure sensor, and then slowly fill my bladder to capacity while monitoring urinary tract responses. Then, as I emptied my bladder, important information would be gathered. She asked me to go to the toilet next door and discharge all the urine that was in me. When I returned, she had me put on a gown and remove my shorts and underpants before lying on the examination table. She draped a green surgical draw sheet across my middle, donned gloves, opened the catheter pack and went to work on my organ.

Having exposed it to view through a slit in the cloth, she grasped it in her left hand, retracted the foreskin and swabbed the glans. The end of the catheter tube was dipped in a sachet of anaesthetic lubricant before being inserted. As the tube was fed through the urethra into the bladder the novel sensation that I experienced was unpleasant but not particularly painful. Once the catheter was in place, I turned on my side, raised my knees and offered her access to my anus. She thrust a cylindrical sensor about the size of a tampon into my rectum.

I carefully got down from the table and stood alongside the electronic equipment and faced the drip stand, one tube dangling from my cock and another hanging from my arse. It was at this point that I realised I had nothing to fear. Even if she had stripped and performed a belly dance my member was now in a state of deep coma and incapable of responding to external stimuli.

The catheter was connected to a litre bag of sterile water that was hung from the elevated drip stand. The sensor cable was plugged into one of the machines and she sat down in front of her monitor. The force of gravity would slowly transfer the water to my bladder, and when I felt a strong urge to urinate, we would know the process had been completed. Then I would empty the water into the commode. She warned me that it could take a good hour or so for my bladder to fill.

In fact, it took over two hours. Two hours of standing in one position while tethered front and rear. It was physically demanding and would have proved excruciatingly boring if she hadn’t been a chatty person. We exchanged personal information and talked about our interests, which helped to pass the time until I finally replied in the affirmative when she asked me for the umpteenth time if I felt the urge.

Getting up she told me she would leave the room while I urinated into the commode. The catheter tube was to remain in place and I was not to worry if there was some splashing. After I had completed a slow and lengthy leak she returned to her stool in front of the monitor and analysed the results. Some five minutes or so later she looked up and smiled. My bladder function was normal and she would report this to Doctor J.

The procedure being over, the mood in the room changed abruptly. Friday night beckoned and we were both in a hurry to get out of there. As she withdrew the catheter tube the unpleasant sensation was similar to the one on entry but a little worse. While she flung the catheter tube into the commode I stood down. She groped under my gown, found the cable and began to pull. When the sensor reached my sphincter, she overcame the resistance by means of a yank, and the device flew out like a cork from a bottle. It, too, ended up in the commode, and as I hastily dressed and threw off the gown I began to laugh. The indignity of what I had just been through struck me as bizarre and ludicrous. What wasn’t funny, though, was that it had cost R5000.

On the 5^th of November, the day after I turned 65, K took me through to the oncologist in Somerset West. This woman, who did not appeal to me in any way, explained how Dr J would implant the radioactive seeds in my prostate gland using a special needle inserted through my perineum, the perineum being the area below my genitals and above my anus. She seemed to take pleasure in telling me about the possible complications and side effects that I might encounter. To my ears the most dreadful of these were incontinence and impotence. She also told me with a smirk that it was not uncommon to experience a certain amount of dribbling. And obviously that would not be from the mouth.

Christmas came and went, the radioactive seeds arrived, and on the 19^th of February 2016 I was back at the Hermanus Mediclinic at the crack of dawn. After checking in and going through the initial ward formalities I donned hospital garb and got into bed. Even though I had taken a laxative and been nil per mouth for 12 hours, a nurse arrived, drew the curtains and told me to get on my side with knees raised. I was to receive an enema. Without finesse she shoved a nozzle up my arse and squeezed the cold contents of the tube into my rectal passage.

“Keep it in for as long as you can,” she instructed. “Then hurry to the toilet.”

After holding it in and then shatting it out with explosive urgency I returned to bed. It proved to be a lengthy wait of nearly three hours as there were two patients undergoing the same procedure before me. When I was finally wheeled into theatre my mood was less than calm and the anaesthesia experience proved to be inferior to my previous one.

Back in the ward I felt warm and under the influence of strong analgesics. After a while I was brought tea and sandwiches, which I consumed in order to restore energy but did so without relish.

Late in the afternoon they came round and said the catheter would be removed and I could take a shower. The nurse snipped through the rubber tube and released the water inflating the bulb that held the catheter trapped inside my bladder. She began to pull on the tube and slowly withdraw it. Again, I felt that very unpleasant sensation that bordered on pain. Instead of following standard practice by restraining my penis with her free hand, she continued to drag the flaccid member with the tube further and further away from its source until it was stretched to its maximum length. She paused, we looked at each other, and she completed the procedure. What the hell was that about, I wondered.

In the morning J made an appearance at my bedside, claimed that he had done what he was supposed to do and if I was feeling alright, I could go. He also said that I would be given a plastic sieve to urinate through in order to capture any seeds that might escape my prostate. These should be stored in a lead cylinder that would be provided, and I should return them for hazardous waste disposal. He warned that I must not allow babies or small children to sit on my lap, and that if I were to partake in sexual intercourse, I was to wear a condom.

K collected me and when we got home, I went into the garden and tried pissing through that sieve. What a mess! What a wet joke! I tried using it once more and never again. A year or so later it occurred to me that what I should have done was urinate into a jug with a spout and then slowly pour it through the fine mesh. Too late.

For two or three weeks I experienced some discomfort but nothing to whine about or pop pain-killers for. One unwelcome and somewhat alarming side-effect of the therapy was the discoloration of my scrotum. Probably as a consequence of the needle repeatedly penetrating the perineum, bruising must have taken place and the sack containing my gonads took on a necrotic shade of purplish black. It must have reminded my wife of the vervet monkeys we had observed with amusement on a trip to the Kruger Park several years ago. It took months for my negroid complexion to lighten and regain its pinkish grey pallor.

About a month after the brachytherapy, I had to go into Hermanus for a CT scan. This was to make sure that my urologist had got his anatomy right and planted the seeds in the prostate and not some other gland. It turned out to be an interesting experience because it made me feel like I was participating in a science fiction movie.

I removed shirt, shorts, shoes and socks, and donned a flimsy grey smock before being led into the space station. Dominating the windowless area was a giant white plastic doughnut. The radiographer told me to lie down flat on my back upon a gurney and to remain perfectly still. She then left, closing the hatch behind her. After a few minutes I felt the trolley begin to move and I was passed very slowly feet first through the centre of the doughnut. A few seconds elapsed, reverse gear was engaged, and I returned head first through the doughnut to where I had started. The radiographer appeared and said the procedure was over and I could get dressed.

On my next visit to Dr J, he told me the scan had proved how accurate he was with the needle and that he had not missed the mark even once. I was pleased to hear this, but I was even more relieved to know that Medical Aid was going to pay the R6000 for my little trip into space.

I was obliged to see that unpleasant woman in Somerset West for one last time and she again told me to expect the worst.

Back at home I decided to embark on a project that would keep me physically active while my body and psyche recovered from the ordeals they had endured. For the next nine months I went about constructing an outside braai room using old building material that had been lying around for more than twenty years.

Three months after the brachytherapy I had a blood test and Dr J gave me a physical examination. With no unexpected side-effects being detected I was to see him again in six months’ time. Two more six-monthly visits went by and then the check-ups were reduced to a yearly routine. Now, more than 5 years after being diagnosed, my PSA level remains low and I feel about as healthy as a decrepit 70-year-old could hope to. However, as J assured me the last time he gave me the finger, with cancer you can never say you are cured.

How right he was. 

To view my longer work as an author, you can find me on Smashwords here.