'My Turn as the Patient'

One night, while watching some television, I noticed something odd. My left testicle had always been smaller than the right testicle. Now there was a subtle difference. If I hadn't felt hundreds of neck masses in my patients, I might have missed this. But, I knew that sometimes finding problems like this early can make a difference.

I realized that this was a decision point in my life. Many people reach the same point where they find something terribly wrong with their bodies. Now I could understand why some people might invoke denial. This is the denial that explains the patient with the grapefruit-sized skin cancer growing from his face, ignored for months until finally the smell becomes too much to handle. I decided that wasn't going to be me.

I found my lump on a Thursday night. Friday morning I called the university clinic and described who I was - one of the chief residents at the hospital - and said that I needed an urgent urology appointment. They told me they had an opening Monday morning. I accepted thinking: No grapefruit for me, thanks!

When Dr. Shepherd examined me, he seemed about to reassure me that nothing was amiss, but then said "Oh, I see what you mean." An ultrasound confirmed the mass; he recommended a radical orchiectomy, which sounded like an extensive garden weeding, but in fact was the removal of a poorly behaving testicle. I proposed this happen during a national meeting a few weeks away, so I wouldn't miss work (denial trying to gain a toehold!) He countered with the upcoming Friday. Oh…

Given the testicle's diminished size, Dr. Shepherd told me it probably never worked normally. He suspected it was one of those cryptic testicles that stay in the abdomen, never descending from its embryological home, and always a risk for cancer. This one had just happened to travel down the inguinal canal and pretend to be a good soldier.

I needed to tell my family. I was single, living in San Antonio. My siblings were scattered across the states. My father had died four months earlier, rather precipitously after a seven-week firefight with lung cancer. His death exposed the presence of early dementia in my mother, which he had hidden well from the family. These several months constitute what I describe as a "bad stretch."

We decided not to tell my mother; it would cause nothing but useless worry and confusion for her. I asked my sister if she could fly into Texas to stay with me while I recovered enough to drive.

I felt fear turned to dread. Not the fear that comes with a kick of adrenaline: fight or flight, the heart racing, eyes dilating. This was fear of the unknown - the unexplored territory of "I've got something bad" mixed with an unhealthy dose of "time to think about it." I was dreading the pain of surgery, the possibility that I might not be able to have children, and the possibility that I might die.

I had the surgery at the teaching hospital in which I trained. My surgeons were Dr. Shepherd and the chief resident in urology, who was also a regular opponent on the basketball court behind the VA hospital. Thankfully, I had delivered very few elbows to his throat that year. The morning of surgery, I thought about marking the incision as a playful reminder of which was the correct side, in a show of surgical bravado, but decided not to confuse the situation. They wheeled me into the prep area, started the IV, and then hit me with the Versed: a moment of intense good feelings, then I woke up in the recovery room with a sterile dressing on the correct side of my groin!

The diagnosis was pure seminoma, the least scary type of testicular cancer. Radiation was recommended. This carried risk to the good testicle, mainly sterility, so I opted to cover my bets and freeze some sperm.

Then, radiation commenced. Compared to the radiation used to blast throat cancer patients, this seemed benign. At least after the treatment I can boast that I have tattoos now, but I have trouble finding them: three blue ink dots that helped lasers target the radiation beams for each treatment. After three weeks, the treatment was finished.

Sometimes life hits us like a splash of cold water in the face. A cancer diagnosis is more like diving off a 100-foot glacier face-first into the icy Arctic sea. A floating freefall, followed by the abrupt, shattering splash. There's life before, and there's life after. We look back at things we've done right, and things we could have done better. In the life after the diagnosis, we scheme about how we can improve the good choices and limit the bad.

I try not to worry. Fate dealt me a hand, and I drew cancer; fortunately mine was one of the better ones, with a high percentage of survival. While I limit my worries to things I can control, I also think we can make our own luck. We do this by taking charge of the factors we can control, like living healthy lives and not exposing ourselves to dangerous habits and environments, and by listening to our bodies and not ignoring unusual signs and symptoms.

I've noticed something about myself and my cancer patients: cancer can turn even the most stoic rock into a bit of a hypochondriac. It's the medical expression of the old adage "Fool me once, shame on you. Fool me twice, shame on me." So when my patients who have had cancer come in, worried about a pain here or a bump there, I don't inwardly roll my eyes or shake my head. I nod my head and tell them they are not crazy or a hypochondriac, and I do my best to put their minds at ease.

A coda… 13-plus years later, and I am cancer free; fingers firmly crossed. Oh, and about those frozen sperm. I eventually married my wife Rose, and after the prescribed year of letting nature take it's course, a batch of pre-radiation sperm was thawed and used for an injection - and with one attempt we celebrated the arrival of the most beautiful baby girl, Sophia. Just as we prepared for a trip back to the freezer for kid number two, another most beautiful baby girl, Kaylee, appeared on her own in the good old-fashioned way. With a combination of amazing freezer technology and great oncologic and obstetric care, I am the luckiest daddy and husband in the world.

John Jarboe, MD, is a voice specialist and general otolaryngologist in Atlanta, Ga. He enjoys golf, playing short order cook for his lovely wife and daughters, and occasionally contributing essays online to Physicians Practice.