I must speak of my favorite pill in the perspective of Christian theology. In order to explain this connection I shall have to include some intimate personal details that I hope will not offend sensitive readers.
A number of years ago I got into a friendly but spirited argument with the Episcopal bishop of New York, whom I encountered at a party on Martha's Vineyard. We were discussing the existence of God. I declared to the bishop that the nonexistence of God could be proved by the existence of the prostate gland. The bishop, a liberal, had been describing Darwinian evolution as the product of “God's divine wisdom.” No wise God, I countered, could have let evolve a biological species, such as Homo sapiens, in which any organ so stupid, so faulty, so prone to disease and dysfunction as the prostate gland had been allowed to exist. Ergo: if God did exist, he certainly was not wise. The assembled guests, who were listening to our discussion, applauded me—at least the men did—but the argument went unresolved.
Some years after this meeting, when I began to experience prostate trouble, I wondered if I might not have courted the wrath of God through my contemptuous skepticism. Maybe the bishop was right. It could be that God did exist, after all, and it was disbelievers like me whom he punished most exultantly by wreaking havoc on their prostate glands. I thought about expressing contrition, but the seriousness of my symptoms convinced me that it was too late for conversion or prayer.
When a man begins to have prostate trouble he experiences difficulties with his plumbing. The problem is often idiosyncratic, varying from man to man, but it almost always involves aberrant behavior of the bladder. Sometimes a man will feel the urgent need to urinate many times a day, discovering that each time he goes to the bathroom he passes only a small amount of urine. Sometimes the flow is not steady, sometimes it is weak; often one has to push or strain to begin urination. All of these difficulties are the result of a usually benign condition in which the enlarged prostate encroaches on the urethra.
In my own case the most serious manifestations occurred at night, when the call to urinate forced me to get up almost every hour. Such an irregular sleeping pattern began to create in me severe exhaustion. More seriously, however, I discovered that my flow was beginning to shut down almost completely. One morning at dawn I realized to my horror that I couldn't urinate at all. I had to be driven to the emergency room of the hospital, where I was relieved of my distress by a catheter inserted into my bladder. It was my birthday. You may imagine the revolting self-pity I felt at celebrating that day as I shuffled around hesitantly with a tube stuck up my penis and a plastic bag attached to my leg.
Of course, I went to a urologist immediately. The doctor examined me carefully and determined that I didn't have cancer. This was a great relief, but then he said that I might have to submit to a surgical procedure to relieve the symptoms. I asked him to describe the operation. He told me jovially that, because the procedure resembled the technique used to ream out sewer pipes, it was often called the “Roto-Rooter.” A long instrument with a blade at the end was inserted up through the penis, and portions of the prostate gland were shaved off; this allowed the return of the urine flow, and the patient began to function normally. Well, almost normally, the doctor said after a pause. I asked him to explain.
There were side effects to be expected, he went on. The most common complication had to do with sexual function. The capacity for orgasm was usually retained, although, he added, a bit hesitantly, some men felt diminished pleasure. More significant, however, was the nature of the ejaculation. He then described a process so bizarre that I scarcely believed it, but it happens to be true. In the majority of cases, the semen was propelled not forward in the usual fashion but backward into the bladder, where it was eliminated through urination. Would this cause one's partner, I wondered, to whisper not “Have you come, darling?” but “Have you gone?” At any rate, as he described this process, known as “retrograde ejaculation,” I began to feel faint. Although the majority of the operations had no seriously negative aftermath, he continued, he felt it was his duty to tell me that, in a few cases, there were complications. I again asked him to elaborate. Some men were left impotent, he said, with no erectile function. What else? I inquired. A small number of patients suffered permanent urinary incontinence, requiring the daily use of diapers.
By this time I was sobbing uncontrollably, but inside, so the doctor couldn't see.
Then his expression brightened. Surgery should of course be avoided if possible, and he wanted me to try a new pill that had just been made available to urologists. Although it was not yet approved by the Food and Drug Administration, many urologists had achieved great success in preliminary tests. Originally intended as a medication to lower blood pressure, it was discovered to have the property of relaxing the muscles at the bladder outlet. The doctor urged me to take the pills home and see if they worked.
Dear reader, to make a long story short, a miracle happened. The pill worked magnificently. For the past five years I have been taking one small five-milligram dose nightly, and my flow has been like Niagara. There have been no side effects. I did not have to have that Roto-Rooter. I do not have to wear diapers. I am not impotent. My semen does not go backward but still spurts out merrily in the direction Nature intended. I am at peace with my genitourinary system and with the world. The pill is a true wonder drug, which demonstrates for me that if the bishop of New York was right and God exists, and that if he is trying to punish men by way of their prostate glands, we have triumphantly outwitted him.
[Egoïst 7 (1985).]