My Work in a Urology Clinic Through the Lens of Shame

Digital rectal exam; drawing shows a side view...

Digital rectal exam; drawing shows a side view of the male reproductive and urinary anatomy, including the prostate, rectum, and bladder; also shows a gloved and lubricated finger inserted into the rectum to feel the prostate. (Photo credit: Wikipedia)

Disclaimer – I am not a doctor.  Do not take anything I write in this blog post as medical advice because that is not my intent.

In 1992, the summer between my junior and senior year in college, I worked for a urology clinic in Hartford, Connecticut compiling data about prostate cancer patients.

Mostly, I compiled data associated with the techniques for detecting prostate cancer.  There was the DRE (digital rectal exam) where the doctor sticks his finger in a man’s anus to physically feel the prostate for bumps that might be cancer.  There was the PSA (prosthetic specific antigen) blood test which detected a specific chemical in the blood that when elevated indicates the possibility for prostate cancer.  There was the ultra sound test where a technician puts a condom and lube on a large dildo looking object and then sticks it in the anus of the patient.  The dildo then captures a three-dimensional image of the prostate using ultra sound.  The dildo was also equipped with a spear gun that could shoot into the prostate and take a section for biopsy to test for cancerous cells.  One time, the ultrasound technician brought me into the room while he performed the ultra sound.  An old man lay half-naked on a table on his side.  He screamed and grunted as the ultrasound wand was inserted and rotated to change the angle of the picture.

I also reviewed patients’ files for treatment information and added it to the database.  Some patients had a procedure called a Radical Prostatectomy (the surgical removal of the prostate).  The chief side effects of this surgery are impudence and incontinence (to varying degrees).  The penis is also shortened by three inches after the surgery. Other patients were treated with radiation beamed at their prostate and others had radioactive “seeds” implanted directly into the prostate to shrink the tumor.  These procedures had similar side effects but not to the same degree as the Radical Prostatectomy.

It seemed to me that all the possible treatment options for prostate cancer were horrific.  I resolved that if I was ever diagnosed with prostate cancer, I would never be treated.  Of course detection and treatment options have improved since that time but I still would be hesitant to undergo any of that especially considering that many cases of prostate cancer are slow to progress and do not require treatment.  I am sure my reluctance to go through these treatments has shame at its core because the side effects I described are shame inducing in men.

Speaking of shame, I suppose I should describe an incident that happened while I worked in the office that I have carried around with me ever since.  A drug company representative came in with lunch for everyone in the office.  This happened frequently.  As we were eating a nurse raised the topic of how expensive college is.  Immediately, my shame radar kicked in and I hoped no one asked me where I went to school because it had a reputation for being expensive.  Of course, someone asked me where I went.  When I told them the nurse looked at another person at the table with a wink as if to say, “this is what I am talking about.”  What was particularly shaming to me about it was that I got the impression she did not think I would notice her doing this.  So not only was I a spoiled, rich kid in her mind but I was also stupid and unobservant.

My father worked for an insurance company in downtown Hartford at the time.  Sometimes I would meet him at his office after work and he would drive me home. I remember being impressed by his office, thinking someday I might work in a place like that.

That summer I had about $2000 of credit card debt. I experienced a lot of anxiety about that debt and looked back fondly on the days when I worked in a restaurant and had no bills to pay.  My father had paid it off and I was paying him back with the money I earned at the urology clinic.

That summer on the weekends I hung out with my cousin and a mutual friend of ours.  The last weekend of the summer the two of them went up to Vermont and I stayed home.  I did not feel like I could go with them because of the debt.  My father put pressure on me not to go because in his mind it would be irresponsible to take a trip when I had a debt to pay off.  I asked my cousin to not go because it would be the last weekend I could hang out with them before going back to school.  He said he would not stay just because I could not stand up to my father.  I remember feeling ashamed and angry with him for this.

Ten years later, my father was diagnosed with prostate cancer and elected to have the Radical Prostatectomy.  I remember him talking about the incontinence after the surgery.  In my life, he has never specifically discussed feeling shame with me (except when I was punished as a child he would say, “You should be ashamed of yourself!”). I assume the side effects of the surgery probably made him feel ashamed.  I think this because my mind reflects the programming I received from him and that he had received when he grew up.  I know shame is the place I would go under the same circumstances. He also started drinking more and became much less communicative after that point in time.  As such, I repeat – if I ever get prostate cancer I ain’t getting treated for it.

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