I first met JB* when the receptionist at the clinic called to tell me that a patient was asking to see me. His name did not ring a bell, and on a quick review of my patient schedule for the week, his name did not appear. I went to the waiting room to see if I at least recognized his face but drew a blank there as well. He looked a little rough around the edges; his clothes were rumpled, and his jeans hung off a belt that, from the look of the holes in the worn leather, was at least 2 inches smaller than it had been previously. He was pacing up and down, much to the displeasure of the many men waiting to be seen in the clinic. He seemed startled when I called his name, and nervous energy emanated from his small frame. I suggested that we go to my office and have a brief chat so that I could learn more about him and what he needed.
My questions were answered by a rapid accounting of what had brought him to the clinic. He was recently diagnosed with prostate cancer and did not know what to do about it. He was unsure about what the treatments he had been offered meant but he had heard that there was someone at the clinic, me, who could help him.
The next 30 minutes were spent with him talking a mile a minute. His bright blue eyes darted around my small office as he told me his history (a series of dead-end jobs, two failed marriages and many similar relationships), his reaction to the recent diagnosis of prostate cancer (he was not sure how this happened because no one in his family had cancer), his fear of choosing the wrong treatment (he had been offered surgery but was terrified of the side effects), and his indecision about ‘the injection’ the urologist wanted him to have. At this point, I had not reviewed his chart or pathology result from the biopsy, and I promised him that if he came back the next day, I would have reviewed all the information I needed to help him. He shook my hand, the rough skin evidence of his most recent short-term work as a construction worker, and said he would see me the next day at 1 p.m.
He did not attend that appointment.
About a week later, he once again came to the clinic without an appointment. He had seen the urologist again and had been prescribed androgen deprivation therapy while he tried to make up his mind about whether or not to have a radical prostatectomy. He was really agitated, once again pacing up and down the hallway. He was supposed to have his first injection within the hour, and he was undecided about that.
Once again we went to my office, and I asked him one question.
“What is it that you are most afraid of?”
His response was a long and winding tale that boiled down to one salient point. He was afraid that if he had treatment, and experienced the very likely sexual side effects of the surgery, he would never be able to find a partner who would accept him without his ability to have penetrative intercourse. There were other issues too; he had no one to support him as he tried to make a very difficult decision. He was lonely and scared and couldn’t tell anyone how he felt. He dreaded coming to the clinic, but this was the only place he could come to and find someone to talk to.
I provided him with an explanation of the sexual side effects of surgery and androgen deprivation that was intended to be a short-term stopgap until he decided what to do about the surgery. I hoped that he would have some erectile recovery as a younger man (age 51) with good erections pre-operatively. I explained what could be done to help him if he experienced the anticipated sexual side effects. I promised I would help him as much as I could as he contemplated his treatment choices as well as after his surgery or other treatment. I told him that my door would always be open to him and that I would make time to answer his questions and provide support.
I have never seen him again.
I think about him often. Did he have the surgery? How is he doing? I cannot look in his chart as I am no longer an active member of his treatment team. I cannot ask any of the nurses for the same reason. I hope that one day, he will arrive at the clinic again, with or without an appointment, and I can close the loop on what he decided and provide him with support, education, and perhaps even help. But so far, I am left wondering.
*Name and details changed for privacy.
Anne Katz is a certified sexual counselor and a clinical nurse specialist at a large, regional cancer center in Canada who blogs at ASCO Connection, where this post originally appeared. She can be reached at her self-titled site, Dr. Anne Katz.
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