Diagnosis/Cure

When I was a boy in Birmingham in the 1950s, Vulcan was, in ways, the city to me.

After 60 years atop Red Mountain, Vulcanthe tallest cast-iron statue in the worldwill have to come down. An engineering study has warned that the statue could collapse as a result of cracks and structural problems. … A colossal effort is now underway to restore Vulcan, the Roman god of the fire and and the forge, to his former grandeur as symbol of Birmingham’s industrial might.

—Birmingham Chamber of Commerce, 1999

When I was a boy in Birmingham in the 1950s, Vulcan was, in ways, the city to me. I grew up in East Lake, a long way from the statue, but sometimes we took class trips there, or I went with my mother and father, or my teenaged sister and her friends. Looking northeast toward East Lake, from the observation deck beneath Vulcan’s feet, I could actually make out Sloss Furnaces, the bell tower of East Lake United Methodist Church, Hayes Aircraft, Chicago Bridge & Iron, the airport and the city dump, where the Klan held their rallies on summer nights and where, Saturday mornings, I hunted for rough-keeled green snakes and the little brown snakes named after the man who classified them. His Christian name escapes me. His last name was DeKay.

Anyway; this was what I could actually see from beneath Vulcan’s feet, but I imagined that somewhere within the spiraling arms of the city, its buildings, viaducts and furnaces, was my place in the universe—my street, my house, the wire fence for Scratch, my part beagle, part shepherd hound. I knew Vulcan could see where I lived and so gave substance to my being. Vulcan certified my existence in that way.

Then one morning in December 1999, when I was on my way to teach at the university, I noticed that Vulcan’s head had been removed and was suspended in midair by a crane. I had read about the plans to dismantle him, but I was not ready to witness his decapitation firsthand.

A few weeks earlier, I had reminded my long-time internist, Dr. Bonnie Armour, to give me a prostate-specific antigen test.

“Why? Are you having problems?” she asked. She cocked her head and looked sideways at me. I was always having problems of one kind or another.

“No,” I said. “But I’m 51.”

“Then its time,” Bonnie agreed. She was equally reassuring when she called to tell me that my PSA-level was elevated. Nothing to worry about: She’d seen numbers many times that high; it was probably an infection; she would prescribe antibiotics. But she also wanted me to get an appointment with a urologist.

Vulcan, by this time, had been reduced to his waist.

The next time I talked to Bonnie, she asked whether I’d made an appointment with the urologist. When I said I hadn’t yet, she lit into me. I was probably fine, she said, but an elevated PSA at my age was nothing to play games with.

“Make that appointment,” she said.

So I did. The urologist, Dr. Jeffrey Cohn, was also reassuring. He had gone to the University of Virginia about the same time I had, and although we didn’t know each other there, we shared a silent understanding about the place and, therefore, about life in general. It had something to do with the school’s fight song: ‘‘Wa-hoo-wa … wa-hoo-wa” I wanted to use the word pudah with him, as in “What’s the pudah on this prostate stuff, Doc?” I didn’t put it that way, though. Virginia had been a long time ago.

“The PSA-level hasn’t gone down,” Jeffrey said, “but it should within another week.”

Unfortunately, a week later, the PSA-level had risen.

“We’ll have to do a biopsy,’’ he said, “as a precautionary measure.”

He was strumming his pencil on his clipboard.

“Biopsies aren’t any fun,” he said, “but they’re not really painful. Just a little discomfort.”

After setting the date for the biopsy, I left Jeffrey’s office in those fine spirits known only to hypochondriacs who smell a diagnosis in the offing.

Vulcan, meanwhile, was down to calves and feet.

I hit the library, bookstores and Internet. I read everything I could about prostrate cancer and stared at photographs of the gunlike device Jeffrey would be using to shoot the biopsy needles up my ass and into the prostate.

It is true that prostate cancer is a common ailment (estimates say as many as 1 in 4 men will ultimately get it) and a generally slow-growing cancer, especially among older men. Cancer cells may hide undetected in a man’s prostate for a lifetime without even causing symptoms, much less death.

But that isn’t the whole story. For many men, particularly those in their 50s and younger, the disease can be highly aggressive and unpredictable. Once the tumor has reached a critical volume, it can break out of the prostatic capsule and race with incredible speed through the body. This accelerated spread had caused the deaths of entertainers Frank Zappa and Bill Bixby. And I read that prostate cancer was the second leading cause of cancer death among American men. Nearly 32,000 would die of it that year.

I started to sink into the scary, obsessive notion that no matter what Jeffrey and the pathologist found, and no matter how sick I might want to be for just a little while, I actually had cancer and was gonna die.

I called my girlfriend, Chance, with this gloomy prediction.

“And what kind of relationship do you envision for us during the six months you have left to live?” she asked.

I was perplexed by her tone. Chance had a quirky sense of hurnor, but still.

In a later conversation, I said, “You wouldn’t leave a man with cancer, would you?”

It was a stupid question. I was still married to someone else. But I was nonetheless a little taken aback when Chance said, “Don’t expect any sympathy from me.”

So I didn’t. I didn’t expect it from anybody. I rolled all the steel doors up around me. Macho man. In sync. I just marched, at the appointed time on the appointed day, to the hospital examination room, where a sonar probe the size and shape of a bottle-nosed dolphins snout was shoved up my ass and pressed at angles to get the right images on the video monitor. Because I was lying on my stomach with my butt in the air and my face pressed to the Naugahyde, I couldn’t see what Jeffrey and the radiologist were studying.

“Hmm “both of them said. “Hmm”

That’s when they brought out the needle gun.

“You’ll feel a little pinch each time one of these reaches your prostate,’’Jefírey said. He warned me about the sound—a cross between a cap going off underfoot and a spring-loaded clothespin-gun being fired. Then he shot 20 needles up me.

On the way out of the examination room, I asked the sonar technician how the test had gone.

‘‘Fine, just fine” she said, with that toothy smile that alerts you immediately to the fact that you are a walking dead man.

I was lucky in a way. I didn’t have to go through another round of biopsies. The first round came out positive. The core samples from the left side of my prostate were inconclusive, but four needles hit pay dirt in the right side.

I really did have cancer.

The good news, Jeffrey told me, was that the Gleason sum was 5, an intermediate score. (The Gleason sum is a rating system, not unlike that used to rank high-school cornerbacks.)

“The bad news,” he said,’’ is that the cells are behaving in a much more aggressive manner than their appearance alone might suggest.”

I imagined a diagram of my walnut-shaped prostate; one half was sprinkled with squiggly little cancer cells. Instead of being concentrated in a well-defined node, Jeffrey explained, the cells were widely disseminated throughout the tissue.

“That’s something we don’t like to see,” he added. “There’s a good chance the Gleason sum will go up once we take out the prostate and the pathologist has a chance to section the entire organ. The pathologist and I also agree that, despite negative findings in the other half of your prostate, we’re going to find cancer in that half, too.”

I called my wife, Vicki, with the news. She said she wanted to go with me to Jeffrey’s office that afternoon for an appointment during which he would go over my treatment options.

Then I called Chance. “It’s cancer.”

“Wait a minute,” she said. “That’s not the way the script’s supposed to read.”

What script? I wondered but didn’t ask at the time.

Anyway,Vicki and I went to the appointment with Jeffrey Cohn, and as it turned out, I didn’t really have any treatment options. Jeffrey said a radical prostatectomy, the surgical removal of the entire prostate, was the only sensible thing to do under my circumstances. I told him I’d read about some patients who had opted for radioactive seeds to be implanted in their scrotums, but he said he had buried too many men with radioactive seeds in their scrotums, so I took his advice against such a conservative approach.

The aftereffects of the surgery were sobering: I’d definitely be incontinent for a while, though six months out, there was only a 10 percent chance of continuing problems with urinary leakage; the worst statistic from recent studies was that radical prostatectomies carried a 60 percent chance of sexual impotence. Radiation held out slightly better odds, but no treatment, other than watchful waiting, which was essentially no treatment at all, could avoid the scary impotence potential.

If I were to choose watchful waiting, Jeffrey said, I would probably be dead within five years, and he proceeded to describe for me the particularly gruesome death that accompanied metastatic prostate cancer: Among its first targets would be the skeletal system, starting with the pelvic bone, the vertebrae, joints and ribs; then the cancer would race on over to the lungs and brain. That certain agony had to be weighed against the possibility of never being able to have intercourse again.

I chose life, but I had to get clearance from my cardiologist before surgery.

My cardiologist, Dr. Andy Morris, had always struck me as a level-headed, practical man. For this reason, î looked forward to my biannual appointments with him. We seldom talked about the literal heart, but we often talked about the metaphorical one.

This time, Andy put the question to me right off the bat: “Is there anything that might be causing you more than usual stress? Aside, of course, from the cancer.”

I told him yes.

He nodded. He probably knew what was coming.

“I’d like for my girlfriend to be at the hospital when I go under,” I told him,’’ but Vicki will be there, too. Its complicated.”

Andy pursed his lips and looked over my shoulder at what I knew to be a pharmaceutical company poster with glossy photographs of two dissected hearts—one healthy, the other diseased.

“Let me relieve your anxiety a little bit,” he said. He looked at me directly. “A man in your situation, facing this particular kind of surgery, doesn’t need to worry about having two women in his life. Because after the surgery, at least one of those women—maybe both—will leave you.”

“Thanks,” I said. “That helps.”

I didn’t sleep the night before surgery. I stayed up to finish writing a magazine article called “When Cancer Strikes Twice,” about a family in south Florida with two children afflicted by a rare form of osteosarcoma that had resulted in tumors at the same spot on both children’s upper forearms.

The younger child, a boy, had been saved by a radical, new surgical technique. Doctors had bolted a piece of living tissue from his shin onto a cadaver’s forearm and then inserted the entire contraption into the space where the boy’s diseased fibula had been excised. The boy was doing fine.

His older sister, for whom the technique had not been applicable, had already lost her arm and shoulder through amputation. She would probably die, although I didn’t know that then. I’d gotten the assignment right after learning of my own diagnosis and thought of it as a godsend. The time I spent with the Florida family had been moving and inspirational. But the predicament of the children seemed like a relatively abstract matter after I faxed the piece to the magazine and got ready for my own Gethsemane.

I gathered up my shaving kit and a few books to read, and Vicki drove me to the hospital where, a couple of hours later, I would be opened from navel to pubic bone and the surgeons’ hands would fish through ray blood for the tumor that otherwise would have killed me.

Vicki and I were alone in the room where they had prepped me. It was an awkward moment.

“Have you made any arrangements that I don’t know about?” she asked.

I had lied a lot in the past, but my reflex, at an obviously critical moment like this one, wTas to tell the truth. I told her that I’d asked our friend Stan to call Chance when the surgery was over, to suggest a good time for her to visit me. It was the only time I’d asked one of my friends to intervene, and I was worried that Stan’s call might compromise his friendship with Vicki.

“Stan doesn’t need to call Chance,’’Vicki said.’’I want to call her myself.”

And so it was that there came this remarkable moment, after the groggy re-entry into the world outside the recovery room, after giving the thumbs-up to a host of relatives and friends, after the realization that I was whole and the operation had gone well—I’d lost a lot of blood, but the surgeons had gotten the cancer, which had been larger than they’d expected and had already invaded the capsule wall and at least one neural pathway to the healthy tissue outside—after all this, Vicki came into my hospital room and said, “Chance is on her way.”

I was drifting in and out of sleep. It was difficult for me to form a coherent sentence. But a while later, I heard Vicki say,’’ Here she is, Dennis. Here’s Chance.”

And there she was at the door, her smile as big as all get-out. No irony this time. Without looking in Vicki’s direction, Chance walked straight to my bedside. I caught Vicki’s eye. She averted her gaze but did not leave the room as Chance cupped my face in her hands. Chance s face and eyes completely filled my field of vision. I felt as if she were looking into the heart of me.

“I love you,” she said softly. And then she backed away, still smiling.

But my cardiologist had been right. One of the women in the hospital room would leave me. It would be Chance.

Survivors of prostate cancer, particularly those who have had the radical surgery I had, seem to mark time by the event. For them, there are two lives: the one before and the one since.

I am no exception. The difference between my two lives is more profound than the one between youth and old age. At least as we grow older, the boy remains within us, encased in wonderment that life goes on as if he didn’t exist.

But this other stuff is like Vulcan being taken apart piece by piece and then reassembled, as he was in the years after 1999, as a stronger, more durable statue though clearly not the statue of the same man. For one thing, he now holds a spear instead of the neon torch that used to glow red when someone in Birmingham had died in an automobile accident within the previous 24 hours and green if no one had.

The spear was what the artist, Italian sculptor Giuseppe Moretti, had originally intended 100 years ago. Standing in a blacksmith’s apron beside his anvil, Vulcan was to appear to be examining a spear point he had just hammered into shape and was now lifting to the light.

This was the statue that had attracted so many admirers at the St. Louis World’s Fair in 1904. But after Vulcan returned to Birmingham and spent his years of internal exile rusting in a field at the Alabama State Fairgrounds, city fathers found a place for him atop Red Mountain. Instead of a spear, though, which was thought to be too warlike and menacing, engineers eventually fashioned the neon torch for Vulcan to hold, thus compromising the aesthetic vision of his creator: The exacting look that the blacksmith appeared to be giving the spear somehow seemed one of befuddlement when directed toward the torch.

My experience exactly, only reversed. I wouldn’t call what I had a spear, but, since the surgery, it has certainly proved as ludicrous as a neon torch that alternates red or green, depending on the outcome of the day’s traffic accidents.

Oh, well. I was never made of iron anyway—just flesh—and we know; even at its strongest, how weak that is.


Authors note: As husband of Venus, Vulcan was also Western civilization’s most legendary cuckold, a fact the Birmingham Chamber of Commerce has never chosen to advertise.

About the Author

Dennis Covington

Dennis Covington is the author of two novels and three nonfiction books, including “Salvation on Sand Mountain,” which was a finalist for the 1995 National Book Award. His latest book is “Redneck Riviera: Armadillos, Outlaws, and the Demise of an American Dream.”

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