June 2015
Attempting to control the uncontrollable was my goal and surely my only choice in late May 2015. I was sixty-three years old, staring at a “serious, stage 3-plus” cancer diagnosis.
Truth be told, if Steve Galen had not been my family physician, this story would have ended much differently for me. Dr. Galen, unlike many other physicians, never would accept as gospel the routine PSA blood test that is part of the annual physical for men. He always insisted on the digital rectal exam. What Dr. Galen perceived as “different” in my exam lead me to (in this order) a urologist, a sonogram exam, and ultimately, a targeted biopsy.
There’s really no way to blunt the cortisol-laced stress response when being notified that a biopsy is on your schedule. It’s even worse when it’s a prostate biopsy, because you’re talking about a plastic gun that fires sharp needles into your prostate gland through your anus to retrieve tissue samples. For some reason that I still don’t understand, this procedure does not include anesthesia. As it turned out, though, the physical pain I experienced would be nothing compared to the emotional wreckage Connie and I would endure in the days after. Following the prostate biopsy, the urologist who performed it—we’ll call him Dr. Smith—informed us that it would take a few days to get the results. In the meantime, he mentioned that he was headed for a vacation out of the country and would let us know the results by email when he received them. A few days went by. The silence was deafening. We called the hospital. They would not give us results without the doctor’s approval. Dr. Smith had left no covering physician who could follow up in Dr. Smith’s absence. This did not sit well with Ms. Sellecca-Tesh. She quickly sprang into action, and we email-bombed Dr. Smith on his vacation to demand the results.
Here is the email chain that ensued.
Good Morning, Dr. [Smith],
We were hoping to get your report on my biopsy asap. Don’t worry about what time you respond. Sorry to bother you on vacation.
Thank you,
John Tesh
Tumor is present, please get bone scan & staging CT, schedule counseling session asap afterward.
Dr. Smith
So. To be clear. Are you seeing evidence of cancer? And what is a staging CT?
John Tesh
Yes. Cancer. Susan will explain & arrange. It’s Gleason 9 tumors.
Dr. Smith
Dr. Smith would not be back for another week. In that time I scheduled the staging CT scan and googled “Gleason 9 tumor.” The Gleason score is the rating system doctors use to judge the aggressiveness of prostate cancer. It goes up to 10. Mine was a 9, which, I learned, meant the cancer tumor was aggressive and would likely travel outside the prostate gland to other organs. Metastasize.
When the doctor finally returned from vacation, we sat down face-to-face with him. He had the test results in front of him.
“Did I do your biopsy, Mr. Tesh?” asked Dr. Smith.
Connie and I shared the same frightened look.
“Yes, you did!” answered Connie, though her exact words were a little saltier than that.
“All right then. Let’s go over these results.”
There were three Gleason 9 tumors and two Gleason 6s. Five cancerous tumors in all. The two Gleason 9s were so large that they were protruding outside the prostate gland, also known as extraprostatic extension. There was a good chance, said Dr. Smith, that a cancer like this would travel into my pelvis and my lymph nodes.
Then Dr. Smith said, “This is very serious. Very serious, indeed. In my opinion it could be inoperable. But if you want to talk to a surgeon, I will give you a number. It might be time to get your affairs in order. My guess is eighteen months.”
The words hung in the air for a moment.
Then, ostensibly to break our stunned silence, Dr. Smith patted Connie on the back and added, “My suggestion is that you go and make lemonade out of lemons.”
Huh? I’m thinking. Lemonade?
I’m pretty sure “lemonade out of lemons” is not in the physician’s handbook of bedside manners. This inappropriate counseling surely had a profound effect on my wife and me. We quickly found the exit to the hospital, vowing to never return. Next? We took a moment to shed some serious tears and pray some intense prayers. We then got busy devouring books and papers on prostate cancer, known as adenocarcinoma.
One of the best resources I found was the 2007 book Surviving Prostate Cancer by Dr. Patrick Walsh from Johns Hopkins. It was written in textbook detail, which I loved. The only problem was that there was very little mention of a Gleason 9 diagnosis. The reason? At the time of the book’s writing, there was no recommended surgical intervention for tumors as aggressive as mine. Terrific. I had hit the cancer jackpot. (The book has since been revised with updates.)
I knew I had to call Dr. Walsh. Cold-calling someone of his stature bordered on inappropriate. Nonetheless I googled his office number. Forty-five years of cold-calling police detectives, politicians, and CEOs as a journalist made it impossible for me to just sit around and wait.
“Brady Urological, Dr. Walsh’s line.”
“Hi, my name is John Tesh. I’m calling from Los Angeles, and I would like to speak with Dr. Walsh. Is he available?”
“Is Dr. Walsh expecting your call, Mr. Tesh?”
“Uh, no. But I just finished reading his book. I’m a journalist and I thought I might ask him some questions about his work on prostate cancer.”
“Oh, well, you may be in luck, Mr. Tesh. Dr. Walsh only takes calls on Thursdays. And, well, today is Thursday! Let me see if I can get him on the line.”
This woman was an angel.
“Hello, this is Dr. Walsh. My assistant says you’re a journalist? She can schedule an interview, if that’s what you’re after. My schedule is full for the next month, but I’ll get her back on the line and you two can work on a date and time. How does that sound?”
“Uh, Dr. Walsh, yes, sir. I’m a journalist and would love to interview you about your work but, uh, it turns out, you see . . . I’m a journalist with prostate cancer. I think you may be the only one who can help me. I’ve read your book twice, and I know you’re the most skilled surgeon in the country.”
Dr. Walsh could most certainly hear the anxiety in my voice. He suggested I email him my test results and said he would take a look. Minutes after I pressed Send, my phone rang.
“Listen, John, yours is a very serious case of cancer,” Dr. Walsh began. “You have five low-PSA-producing cancer tumors and what looks like an extraprostatic extension. If you don’t have surgery soon, this could spread quickly to your bones. That’s what prostate cancer does.”
“Dr. Walsh, I’ve read that you’ve done hundreds of the new robotic prostatectomies. Can you operate on me?”
“I’m sorry. I’m not operating anymore,” Walsh said quickly. “I no longer perform this surgery.”
I swallowed hard.
“John, there is one man who I believe can save your life. He treats aggressive cancer aggressively. His name is Dr. Ted Schaeffer. He’s a PhD-MD who is an expert with robotic-assisted surgery using the da Vinci surgical system. I trained him myself. With your permission, I’ll forward your test results. May I give him your number?”
I agreed, and five minutes later, Dr. Schaeffer was on the phone. He was calling from his car. Connie and I were glued to his voice on the speakerphone. What Dr. Schaeffer told us on that call was a true gift in a time of very deep need.
“Don’t worry, John, I can save your life. This is what I do. You’ll be fine. But we have to act quickly.” And then he repeated Dr. Walsh’s words, almost verbatim: “I treat aggressive prostate cancer aggressively.”
In a matter of a few weeks, I had seen four doctors. With each visit, each phone call, the seriousness of my predicament came into sharper focus. Now it was clear that I would have to have my prostate removed through this robotic-assisted radical laparoscopic prostatectomy. Connie and I were in agreement that we would place our faith in Dr. Schaeffer’s expertise and experience, so we booked our flights to Baltimore and set a course for the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.