The patient doctor: Marcy beaucoup

“Preparation for a Prostate Biopsy” is a light summer read but will never make it on the NYT bestseller list. I visited the local Shoppers Drug Mart to fill my prescription for Sulfatrim DS and pick up an OTC Fleet. I was surprised to learn that “supply chain issues” had resulted in an enema shortage. Imagine a world without enemas. I was able to source one at a small independent pharmacy where several had been hoarded for these types of medical emergencies. I followed the instructions as provided, and two hours prior to the procedure carefully placed myself in the driver’s seat of my wife’s Toyota Camry. She accompanied me and would busy herself for a few hours after the drop-off at the Odette—perhaps at Costco. I cleared customs at the cancer centre door and proceeded to registration for my brachy clinic procedure. And then I positioned myself in the reserved seating section in the expansive waiting area. “Howard, please come this way.” I was being summoned. I stood, acknowledging that I was, indeed, Howard, and was escorted through the electronic doors by a nurse. “My name is Marcy and I will be with you from now until you are discharged home following the biopsy.” I hoped that Marcy wouldn’t have to put in for overtime. Marcy showed me to the change room, advised about the dress code, two gowns, one put on from the back, the other from the front, for the comings and goings, and assigned me a locker. Once the wardrobe was complete, including booties and hair net, I returned to the nursing area in my new role as a prostate biopsy fashion influencer and was seated in a hospital-issue La-Z-Boy. Marcy proceeded to record vital signs and began the lengthy “checklist manifesto” necessary for any invasive procedure. She then reviewed, in detail, the minutiae associated with trans perineal biopsies, descriptive to a fault, but allowing ample opportunity for cross-examination. If there had been a YouTube video, I probably wouldn’t have watched it anyways thanks to my squeamish tendencies. Marcy was thorough and very reassuring. “The procedure room looks just like an OR,” she advised, another attempt to diminish the anxiety of first impressions as I was perp-walked into the room. The oncology fellow would be the maestro today, conducting his attentive nurses and technicians and hopefully, successfully impaling the focal lesion in the depths of the left lobe of my prostate with his “baton.” I was seated on the side of the operating table, then asked to swing my legs around and assume a supine position. Gowns were adjusted on my behalf, and with full consent. I was asked to raise my legs, bent at the knees and was unceremoniously splayed laterally and guided into each of the stirrups. This was my first foray into lithotomy posturing, a position I continue to visualize as a recurring image, featured in my ongoing post-procedural night terrors. Drapes were placed strategically, however my lower quarters were relegated to full disclosure. The oncology fellow began the dialogue. “You’re going to feel a brief pinprick as I insert the local anesthetic in the perineal skin and then a deeper sharp sensation as I inject Zylocaine into the nerve plexus around the prostate,” or something like that. I was lost in the translation. He described the brief shotgun sensation, popping sound and corresponding jolt when the biopsies were taken. I visualized the gunfight at the O.K. corral. This sequence of “assaults” would be repeated in my/the neighbourhood of nine to 12 times, I was reminded. Marcy remained seated at my side. She leaned in and said, “Hold my hand and squeeze as hard as you have to. I won’t let go.” I felt the first needle and squeezed Marcy’s hand as instructed. The fellow advised me to put my bottom back on the table and relax. Ya, right. He reminded me that I had needles being inserted into my perineum and, an ultrasound probe somewhere in the depths of my Southern Hemisphere. I complied. With the deeper local injections, I got into a rhythm of sorts, reflexively levitating my buttocks with each intrusion, all the while, squeezing poor Marcy’s hand. I apologized for gripping so forcefully. Marcy was unfazed. I’m sure this was not part of her job description, but, she had adopted this methodology based on compassion and caring and empathy for her patients. As a distraction, Marcy began to ask me some general questions about myself, my practice and my life. I was happy to talk, especially if it would transport me elsewhere, even for a brief moment in time. At one point, I was fly fishing in a raging river in Montana. I have never been to Montana! The strategy worked for the most part, until it was announced that “we” were now “moving over to the other lobe” for a reprise of the first movement of this “unfinished symphony.” Marcy and I continued with our conversation until I heard the snapping of latex as the fellow stripped off his gloves and announced that the procedure was completed. It took some time to dismantle the supra-structure and return me to my original state, more or less. I sat on the edge of the table, still clutching Marcy’s blanched fingers. The fellow advised that all had gone well and that he had extracted multiple focal and systematic samples for pathological assessment. I was to review the results with the oncologist on a yet-to-be-determined date, likely a virtual phone call. I had a number of additional questions that were answered while others went unspoken, for now. Marcy assisted me in the return to the change area, and gave me explicit instructions as to some of the really personal care issues related to the procedure and its aftermath. She asked that I check back at the desk once I was ready to leave. I was past ready. Marcy guided my long-anticipated exit through the confusion of hallways to the main waiting area. She established that I was fit for release. I thanked her for everything she had done on my behalf, her professionalism, compassion and personal touch. She had guided me through the darkest day and returned me safely to the light. Next on my summer reading list: “What to Expect after Prostate Biopsy.” Marcy, thank you very much!

The patient doctor: Marcy beaucoup

Register for free access or login.

More Blog Posts in This Series

Doing time: Hallway medicine is out of hand

Senescence

The patient doctor: Leaving my MRI distraction playlist behind

Blog Author

HOWARD GOLDSTEIN

Related Topics