A TRIP TO PLUTO

Saturn, Uranus, Neptune ... As an aerospace engineer and interplanetary navigator, I've been to all those places via the Voyager mission. Done 'em! My life is fraught with adventure every few years, one planetary encounter after another. But I've never done Pluto. Never been to that deep dark place full of shadow, cold, and potential finality. I get a chance now. If you are one of over 200,000 men in the United States diagnosed with prostate cancer this year, you may also qualify for the trip.

It all comes down to an adventure. Never mind if it's good or bad, I won't know for another few hours. If ever. The unknown beckons: danger, excitement, risk, reward ... and an undetermined outcome. Only the "if ever" gives me pause.

They come for me, two orderlies, men, black and white, eyes hiding deference, pity, boredom. They fiddle with the gurney outside the door while I fiddle with my thoughts. Is it too late to run down the hallway, smock flapping in the breeze exposing my bare bottom, screaming No, no, no, not me, not today, not ever, take somebody else!

No. Not too late until they actually lock me down in drug chains. Not too late to scream, but I don't scream or run. Instead, when they are finally ready and look expectantly in my direction, I give a big jump into the air and click my heels together. Come down smiling -- Ta Ta! -- and climb onto the gurney. They've never seen that, I'll bet. Never!

I'm cold, and the first thing they do is drape blankets over me. Warm blankets, fresh from the heater. I'm grateful, and shrink up a little so they cover the length of my body from neck to toe.

Down the hallway feet first. Bye bye, Jan, I love you. Bye bye, don't worry. Down the hallway on my back, feet first through doors, past busy doctors and nurses and waddling patients, reminds me of the pregnant woman in the movie "The Meaning of Life" on her way to a rendezvous with delivery and "the machine that goes beeeep!"

Four months earlier I had grunted with pain as a doctor probed my guts with a thick plastic/metal wand pushed up my anus. The pain isn't bad -- bearable certainly. It's the pain of injured dignity that hurts most. The floor is slippery with the blood of humiliation. I see the shadowy outline of my prostate rolling and sliding across a video screen as the doctor watches intently. OK, let's get some samples, he says. I steel myself. Snap... Snap ... six times Snap, the tiny needles dart. At least it's sudden, a quick bite and tug, over instantly. A small quick pain. Six snaps and it's over and as I pull my underwear and pants up, he tells me to expect a little blood in my urine for a day or two, and I might have bloody semen a month or so. I'm a little shaky, have to walk gingerly, but it's not too bad. Bearable. We'll get the results Monday, he says. Make an appointment. Monday? Today's Wednesday. I have to wait almost a week?

The PSA score had been climbing for years. I'd gotten the first one when I was 49, and it was below 4. Four years later it had climbed almost to 7. Worrisome, but not alarming. Finally, when it topped 10, I had my first biopsy. That was last year. Negative. Relief. I know it had been a relief, because I cried. The nurse had called on Friday, after two days of agonized waiting, and said, I just want to let you know right now so you won't worry over the weekend, that the biopsy was OK. I held it together for a few polite words of thanks, but as soon as I put down the phone, alone in the house, I was a ball of tears. Oh God, Oh God, Yes, Oh, God, Thank You. And I don't even believe in God.

Over the course of the year, the PSA had dipped down to 9, then climbed again, above 12. Now, when I'm 55, the biopsy is easier, the wait easier. But this time is different. I have a new doctor. A new nurse ushers me into his office to wait alone a few minutes. The formal office, the VIP office, the good-folks office, plush carpet, walnut furniture all around, books and diplomas lining the walls. Not the usual steerage patient's room with the intimidating paper-topped examination table.

Uh oh. This can only mean one thing.

Something turned up in two of the needles, the doctor says. Oh?, I answer, but I already know. Cancer! I have cancer. My status has changed with the status of the cells picked out of the tips of the needles. I am now a cancer patient, and people look at me differently, those who know. My life has just changed, I have joined the society of untouchables. But somehow this time it's easier than the false alarm of the year before, somehow it's almost old news, has the aura of calm inevitability, humdrum fact.

Pain ahead! I stand in the middle of a highway, arms and legs splayed out spread-eagle as a truck approaches. But the emotional content was squeezed out a year ago, and with this doctor I'm almost unconcerned, almost jaunty. He says, You need surgery before this stuff breaks out of your prostate. I say No way, I'm not missing the launch of the spacecraft I've put seven years of my life into. We agree on a hormone treatment to put me into a holding pattern for four months to shrink the cancer. The countdown begins. Two months later, Cassini thunders off the launching pad on its way to Saturn while I gird for my trip to Pluto.

They park me in a holding room. Cocooned in my gurney, looking past my feet through a doorway, I see into a corner of the main arena, the operating room where I will shortly be the center of attention. Vague shapes lurk there: lamps, equipment, predatory animals moving out of sight, shadows sliding through unseen spaces. A heavy truck approaches, speeding out of control, and I spread my body wider, preparing for the embrace.

But first I have to pee.

The day before, I came for the labwork and the final presurgical evaluation. My EKG has a glitch. Don't worry, it's nothing, the surgeon says. I have a mild temperature. My blood pressure, which is usually quite good, is sky-high, 205 over 102, the worst ever. Don't worry, the nurse says, but she takes it again with a frown on her face, and this time it comes up 195 over 96 and she's satisfied. What's the threshold? Don't worry! But I AM worried. I don't FEEL nervous. Now I've got something else to deal with after this damn operation is over. High blood pressure. I'm NOT worried, I AM worried. They're going to operate on me like this?

Over the last several years, the surgery has become a lot less bloody and shorter in duration, meaning there's less trauma to recover from. Since 1994 the typical duration went from four hours to two or three, the hospital stay from five days to three or four, and the recovery that used to require eight weeks now needs four to six weeks. Why? Technique, the surgeon says, and shrugs. We just keep on getting better. Still, this is major surgery, and there is a nonvanishing probability of complications leading to death.

Small. But not zero.

In the middle of this internal chaos, a minor earthquake hits, gently swaying the building, obviously a foreshock to the magnitude nine disaster that will inevitably occur tomorrow while I'm opened up on the table.

The hour before, waiting in the room with Jan, my bladder was in turmoil, I had to pee every five minutes even though it was after nine in the morning and I hadn't had anything to eat or drink since ten the previous evening. Where was it coming from? Now again in the holding room, an urgency asserts itself. This is insane, I think, as the nurse lets me off the gurney and I pad alone down the hallway in smock and paper booties, a calf straying from the slaughterhouse queue. The bathroom is locked, occupied. I wait and wait. Insane! Finally the door opens. A cleaning lady. Oh, pardon me, she says, slipping by. I pee and think, This is the last time I'll do this for a while. If ever.

The anesthesiologist comes over to fiddle with me, a small, intense woman. I smile and say Hi, but she's not much for small talk. She searches for a vein in the back of my left hand, inserts a needle and tube, tapes it down. It irritates at first, but later I will hardly notice. The truck is almost on me, I hear a blast of air horn. Jan, Louisa, Chelsea ... Chelsea ... I love you ...

Our outermost planet is cold and dark, getting 900 times less heat and light from the sun than does the Earth. You will experience no discomfort upon arrival, however, because you will be in a state of suspended animation even darker than Pluto, void of memory, dreams, consciousness, or even existence.

I swim to consciousness. I know immediately what has happened, but it's unimportant, not worth dwelling on. The only thing worth dwelling on is my back as I lie serenely waiting for the distorted images in front of my eyes to firm up into reality. It takes -- how long -- two minutes? Ten? Doesn't matter. I think I'm in the recovery room, but it looks a lot like the holding room, who cares? Holding, recovery, I never got to see what was between them, the arena, the floodlit playing field, the combatants brandishing knives and smiling mightily over unsullied turf.

This isn't so bad. Not so bad? It's great! The "if ever" DIDN'T ever. I'm still alive. There is no pain to speak of, no contingencies to fret over. Obviously I'm drugged, but it's a happy daze and I'm completely satisfied to drift in and out of sleep as I lie flat on my back, motionless and senseless.

The operation started 10:30 in the morning and lasted three hours. When I'm finally back in my room. Jan smiles. The prostate is out! It had shrunk and was sticky and a little difficult, the doctor says, because of the hormone treatment, but it did not appear that the cancer had breached the capsule, and they had been able to spare both sets of nerve bundles that run along the organ. Recovery of sexual potency is possible.

The first night is good. Perfect temperature! I've never felt so comfortable, lying flat on my back with no duty whatsoever but to drift. Blue leggings with air bladders like a pilot's g-suit inflate alternately, left, right, left, right -- encasing, squeezing my legs to prevent embolism. A tube blows cool oxygen into my nostrils, and an IV drip, drip, drips into my veins. The Plutonian traveler has plenty of life support.

Nurse Jones asks, On a scale of zero to ten, what's your pain level? I like Nurse Jones -- the balm of empathy exudes from her pores. Three, I lie. How can I tell her it's one, or maybe even zero. There's supposed be suffering, isn't there? I feel the tubes running in and out of me, watch the drainage bag on my abdomen fill with a cherry red liquid, but I don't hurt. At all! Occasionally, I punch the button clipped to my smock to deliver a little extra morphine, whether I need it or not.

The clock! Slowest clock in the solar system! Drift for hours in a tranquil trajectory back towards the sun, then look up and the hands have moved five minutes. Love it! Let time stop, I get my pleasure from rest, not sleep, floating in perfect comfort.

The next morning, there is an incremental return, a baby step back toward reality. The truck had hit, all right. I just don't feel the pain. Breakfast is broth, chunks of cherry Jell-O, and tea. The broth goes down and stays, and then a few bites of Jell-O suddenly want to come up again. I hold the kidney-shaped plastic pan under my mouth and gag. It's amazing how much you feel like you're going to die just before you hurl. A few liquid drops come out red. Blood? No. Cherry. After a while the ubiquitous Nurse Jones comes to help me shave and clean up.

For lunch: broth, tea, and Jell-O again. This time it sticks. Even better, Jan brought a cup of ice cream! I go for a walk. Now the reality comes on strong: You'd better move slow, the slice in my abdomen says, grinning vertically from belly button to pubic bone, or I'll open right up and spill all your guts out on the floor! It's a definitive statement, and I listen and move slowly indeed, leaning on my IV cart handle and my nurse. No heroics here, just get thirty feet down the hall to the nurse's station, then turn around and come back and collapse, slow-motion exhausted into bed clutching the kidney bowl as nausea returns.

In the afternoon my mates from work come to visit, seven of them. I'm touched. Engineers and space cadets all, navigators to new worlds, we're not a sentimental bunch, but here we are doing our sentimental thing. I feel like I need to entertain, show a little energy, exude a little bravado. It's not that bad, I act, and in truth, it's not. I feel pretty good, I say, and in truth, I do.

Dinner is served. Tea, broth, Jell-O. Again, the night is blissfully long and the temperature perfect. I have no duties but to get well. I watch TV, I sleep.

I'd come Tuesday. Now Thursday for breakfast I have solid food at last, and afterwards it's time for the IV to come out! Rejoice and take a difficult shower and grunt a little with gas as the intestines begin to stir with life again.

The truck recedes into the distance, but as I make my plans to go home the next day it begins to sink in that I'm recovering roadkill, that I've been run over by every wheel on the truck. It's going to be a while before I'm normal again. If ever.

We've planned ahead. For my hallway strolls, instead of depending on those damn peek-a-boo smocks, I'd packed a nice bathrobe. For the trip home, because I have this junk hanging out of me -- the catheter in my penis and the drainage bag on my abdomen -- Jan had gone out to buy boxer-style shorts. I try one on. Way too small, and it doesn't open in the front. My waist is bloated from the surgery. Another shopping trip fetches shorts with 3 inches larger waistline and snaps that open in the front. Perfect.

My penis and scrotum are grossly swollen and discolored. No books I read had mentioned this, and I worry. The doctor, with calm assurance and pleasant bedside manner explains: We removed both pelvic lymph nodes. The lymph system re-pipes itself eventually, but meanwhile the fluids have nowhere to go and settle into the lowest place in the abdomen. How long? It's slow, he says. It'll shrink gradually over a few weeks to a month. Meanwhile, I walk bow-legged with mincing little steps.

The third night is worst, not from pain or discomfort, but because I'm out of the euphoria survival, into the ennui of long-term recovery. In the morning, I grunt cautiously for nearly a half-hour in the bathroom to generate the obligatory pre-checkout BM which tells the asylum attendants that the bowels are awake and functional again. After that, I get a little instruction on tending the catheter and the drainage bag. There are two urine bags: a large one for bedtime, connecting by a long tube to the catheter, and a smaller one for mobility, strapping onto my upper leg under my trousers. Unfortunately, I have only one pair of trousers large enough to accomodate my enhanced waistline

Finally, it's time to go. I wrap up in my bathrobe and a nurse pushes my wheelchair to the hospital entrance. I ease very gingerly into the front passenger's seat of Jan's car, and we drive three miles home. I do not like the bumps at all.

The first day home is the worst of all. I feel grotesque and invalid. I get a little weepy. Small things touch me off. I hate for my daughter, Chelsea, to see me this way. I take pain-killers every four hours, but it's more to dull the emotions than to ease the pain.

The second day I take a trip to my computer and send Hi to e-mail buddies. I move very cautiously. It takes almost a minute to get comfortable in the swivel chair.

The third day, Sunday, is uneventful, but Monday is full of good news. We return to the hospital to hear the pathology results. It is the best report possible: There was no cancer in the removed lymph nodes; it appears to have stayed entirely within the prostate. I'll be looking over my shoulder for the next several years, but the odds are good for complete recovery!

Rhapsody! Bring on the pain, I don't care! Now I can enjoy watching James, the physician's assistant, remove the drainage bag and pull out the tube that feeds it. It comes out slowly, a piece of glistening gray plastic rolled up into a long tube. There is no pain at all, but a sucking, cavitating feeling, not unpleasant, deep in my abdomen, as if he were pulling out a length of intestine. There remains a sizeable hole in my lower abdomen just to the right of the incision. It looks like a fatal open spear wound, but in fact it will heal rapidly in just a few weeks from the inside out.

Thirteen days after surgery, I prepare to return to the hospital to have the catheter removed. In some ways this ornerous appendage has been the worst part of the whole experience, a constant irritation and reminder of my own surgery-induced frailty. Getting it out is easy and painless, I've heard. We'll see.

I've begun to move about easily, and now I can lean over from a standing position and pick small things off the floor. Doc says I shouldn't lift anything heavier than a book for six weeks.

After the catheter is removed, there will be an inevitable period of incontinence lasting anywhere from a few months ... to forever, if I am one of an unfortunate 2 to 4 percent of men. After incontinence worries are settled, questions of sexual potency will come forward. Since the nerves were spared, my odds are better than even for recovery in this area, but not by much, and it could take up to a year or more.

Adventure, excitement, danger, this is one man's trip to Pluto. The major worry before surgery: Am I holding a one-way ticket?

Since my round-trip ticket was confirmed, I've been occupied with making the return as comfortably and quickly as possible. And it has been, with a few ups and downs. I'm back into the inner solar system now, inside the orbit of Mars, Earth in my sights, straight ahead.

If you get a chance to take this trip, prepare for the worst, hope for the best, but most importantly -- put on an attitude. This is an adventure, and like all true adventures, it combines danger and excitement; balances palpably uncertain risks against rewards.

Bon voyage!

January 1998

End