The small c and the big robot

Few of you should care but for those who do, here’s a chronicle of my experience in robotic surgery for prostate cancer. I post it here mainly for the ongoing Google value to those who follow me into the O.R.

da-vinci-robotAt 9a Monday, I walked into the bright operating room at Sloan Kettering and faced the robot. Pictures of it on the manufacturer’s web site make it look small, like something that might screw in radio knobs on a Cooper Mini: friendly. In person, the robot is huge, like something Sigourney Weaver would defeat in space: imposing. I saluted it and backed away. Its arms stood at ease, each covered in plastic to maintain its sterility. I also saluted the surgeon, Dr. Raul Parra, who works many feet away at a console that gives him a video view inside me – much magnified – and delicate control of the five arms poking inside my belly. They also pump me up with CO2 to give the robot room to work and the doctor room to see. One friend made reference to me becoming a Macy’s Thanksgiving Day Parade balloon and envisioned shooting me down over Broadway.

The waiting-room nurse told my wife that they put patients under anesthesia an hour before surgery begins because that’s how long it takes to set up the robot and patients tended to get a little freaked seeing an alien beast assembled over them, ready to drill in. It’s one matter to be scared of needles, another to stare at a robotic arm with electric scissors on the end.

While he’s inside, the surgeon tries to peel back and preserve the nerves that encase the prostate because they’re the ones that enable erections. In some proportion of cases, the patients get that magic talent back; in some cases, not. That’s why doctors now prescribe Viagra before and after (“use it or lose it,” another doctor said to me – a new answer to, “not tonight, dear, I have a headache”). The surgeon takes out the seminal vesicles, which means that orgasms, when and if they return, are no longer messy. Out go a few lymph nodes. And, of course, out goes the prostate and a piece of the urethra with it. That’s why men also have problems with continence. “We have to re-potty-train you,” said my doctor’s nurse.

After surgery, the doctor said my cancer appeared to be contained to the prostate. That’s the key question. If it is, then my PSA – which was rising and led to the discovery of my cancer – should fall to nil. If it isn’t contained, then the cancer can spread to the bones (that’s what killed my grandfather) and then treatment could include radiation and hormones (to cut off the testosterone that feeds prostate cancer).

When I woke up in full morphine-induced stupidity, I had five small holes in me – the largest just big enough to bring out the prostate – and two drains, one in my side (which was taken out before I left the hospital – a very eerie experience, having a foot-long french drain pulled out of your belly), the other where I had been dreading it. When I scheduled surgery, the nurse volunteered to show me a Foley catheter. I declined. Funny, she said, everybody does. In my mind’s eye, I saw a thin stick up my dick and that was bad enough. But I woke up to find a garden hose coming out of my penis (the subject of one of my earliest tweets once I got my iPhone and lucidity back). As the Howard Stern Show’s Gary Dell’Abate told me about his stent up there, the problem isn’t so much pain as feeling things move where they shouldn’t.

I wrote a Guardian column about choosing to reveal my cancer on my blog and the benefits that come from it. There’s no greater symbol of giving up privacy and embracing publicness, I think, than writing about one’s penis, especially when it malfunctions. But in the hospital, I lost every last vestige of modesty. There’s just no point. Nurses need to fix things there and give instruction on how to cope with the catheter and you are completely, utterly exposed. There’s a young, female nurse, speaking at eye-level to my penis telling me what to do with it as it sits in extreme repose. Think Seinfeld’s shrinkage episode; cold water and catheters have the same effect. By Tuesday, my last bit of third-grade immaturity about the subject of penises died.

Now I have to manage my catheter. Warning: appetite spoiler coming. As my wife said to the kids, “Daddy’s going to be disgusting for a few days.” I have to empty and change a bag strapped to my leg during the day and a bigger one that hangs by my bed at night (but it’s not big enough to get me through the night and let me tell you, you don’t want this thing to back up). As with all challenges, once you’ve faced it, it’s not as daunting as the dread.

My pain isn’t awful, either. I have enough Vicodin to keep Artie Lange or House happy for a month but so far I haven’t used any, just one sleeping pill to date. It hurts my stomach to stand up and lie down – and, gawd, you don’t want to burp or cough and I don’t want to know about sneezes – but that’s momentary. It’s really not bad.

If I had chosen radiation instead of surgery, I would not be dealing with problems of plumbing malfunctions now, but there’s a chance those could come in a few years. And it’s also not possible to be assured that the cancer is gone. There’d be more hanging over my head. So at my age, I’m still glad I chose this course: out, out, damned spot.

I’m well aware how lucky I am. Prostate cancer can be cured; the treatment has its inconveniences but nothing next to so many other forms of the disease. Mine was caught early but my timing was good insofar as robots had been invented and perfected. My unit at Sloan Kettering was filled with nothing but prostate cancer cases like mine. My wife sat in the lobby and saw parents wheeling in a child’s dolls and books for a long stay. That’s what makes the place break your heart. My inconveniences are easily put into perspective.

As I finish this post, it’s Thursday afternoon. I’ve slept through the night, avoided most plumbing disasters, just took a mile walk (at a crawl’s pace), am eating well, and have even had a first glass of wine. I’m probably doing better than I thought I would. One friend took over my class this week and another will next week, but in a fit of optimism, I hope to have my hose-ectomy on Wednesday morning and then go into the city for school that afternoon. We’ll see. In any case, it’s good to have cause for optimism.

I’ll continue to update you on my condition, as warranted.

  • kevin Lately

    Thank you for sharing your journey. My father died of Prostate cancer; not caught early enough. My Older Brother Patrick caught his prostate cancer early and is doing well; a year after his surgery.
    I wish you the best on your sojourn back

  • It takes guts to talk about this publicly, but you are the king of full disclosure.

    Take it easy, man. All that other stuff can wait.

  • great jeff.
    i am learning so much,
    keep it up and and i know you will,

  • Here’s to you for a quick recovery.

  • YoDaveG

    Thank you for being so open about your experience. As an over-50 male I worry about these things, and your equanimity is reassuring. I, too, had my first catheter experience recently after a cycling accident, and, well, forget modesty.

    I wish you a speed recovery and many successful erections.

  • magellan

    Thanks for sharing the experience. It is a learning tool for all of us who are contemplating the surgery or trying to decide between surgery and radiation. This is truely what the web can be. Best of luck on your return journey. Hope to see you back soon on this week in google.

  • Jeff — such is the progress in modern medicine…

    …back in the pre-robotic days of 1996, a post-surgical hospital stay was two nights, not one, and the catheter stayed in for four whole weeks not ten days.

    As for the catheter, you do not have to worry about being disgusting. It is only urine, after all. What you have to be on the alert for is to keep your stool as soft as you can. The slightest need to push during a bowel movement squeezes the catheter the wrong way and is exquisitely agonizing.

    Concerning orgasms, it is so gentlemanly of you — speaking as a babyboomer member of the pre-condom generation — to look on the bright side that the lack of semen removes the mess. A small caution: do not underestimate the physical pleasure of ejaculation. When all you feel is a spasm instead of a spurt, you will miss it, I fear. As for erections, you will find that your first orgasms will occur before your first hard-ons. Coming while being soft is a bizarre, disquieting sensation.

    I contribute these tidbits in the spirit of “ongoing Google value” as you put it. Good luck — Andrew.

    • Andrew,
      Thanks for sharing. I mean that. j

  • JHMcFadden

    It looks like Wall-E’s mortal enemy. I would have been terrified. Brave of you to have the surgery… and brave of you to talk about it. Glad to hear you’re recovering.

  • AnnB

    Wishing you a speedy and full recovery.

  • rosdj

    Thank you very much for sharing. My dad just had this exact procedure done yesterday and it’s very interesting and helpful to read the account of your procedure as well. Hope your recovery continues to go well!

    • Best of luck to your dad! If you need to bounce your experience off someone a few days ahead, please feel free to email. j

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  • Made my legs go to jelly (why does that happen?), but kept reading. Thanks for sharing and best wishes.

  • Hi Jeff,

    Your book What Would Google Do is my professional bible. It’s brilliant. Your writing about the development of the web is entertaining, uplifting and inspiring.

    Your post about your operation is very graphic and very brave. I wish you a speedy recovery.


  • I woke up after surgery once with an unexpected catheter and a sense of “WTF!?”. I found I became accustomed to it in a day or so, and fortunately didn’t have to live with it for more than a few days. In general, I think, men are much more anxious about medical devices in their junk; it’s really not a big deal, which is another reason why it’s great that you’re talking about it so openly.

    Hope the recovery goes quickly. We need our Jeff.

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  • “As with all challenges, once you’ve faced it, it’s not as daunting as the dread.”

    Thanks for all your posts, Jeff. I have my surgery date (also robotic) of October 21 for prostate cancer and you are helping me to face it one day at a time. In all honesty, I’m completely freaked but it is being able to read your account and some of these comments that make me better able to face what’s ahead.

    My best wishes for a speedy and complete recovery. As others have written here, we need you.

    • Jamie,
      I’m only four days out, but it is getting better each day and the freakishness diminishes. I’m pulling no punches so I hope you’ll have no surprises. Best of luck and don’t hesitate to email if you have more questions.

  • lewis

    get better soon

  • Wow. That is very brave of you both to go through the surgery and then to so publicly discuss the cancer and procedures here. To hear if from someone as it is happening allows the rest of us to learn some more about this. Good to hear you are recuperating, and I hope everything keeps going on well.

    Best, and keep on blogging.

  • The best piece I have ever read about this or any medical procedure for that matter. Bravo! Brave and brilliant all at the same time.

  • Yikes. If I saw that robot coming at me, I might have shot it with my blaster!

  • Jeff,
    Your decision to undergo prostate surgery and share your story (including all personal details) are courageous acts. Godspeed with your recovery.


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  • Tex Lovera

    Jeez, it hurts just reading this.

    Good for you in being able to face this head on. May your further recovery be complete and speedy.

  • michael

    jeez, and you wonder why you called your blog “Buzz Machine”!

    sorry, couldn’t resist…

    kudos to your for sharing this ordeal/procedure/event…

    even if it leads to having one guy getting his life saved, you’ve done a great thing.

    speedy recovery.

  • Hang in there my man!!! We’re rooting for ya!

  • I just finished 6 rounds of chemotherapy for my cancer (lymphoma). You and others mention the dread and fear – that’s the major part I had to overcome also. Thanks for sharing. Also, learned 2 weeks ago that my cancer is now in complete remission — giving you a shout of hope!

    • Congratulations, John. Candles lit & fingers crossed.

  • Len

    Glad to hear you are doing well. Thank you for sharing this.

  • lol. patients should definitely pursue all options when under going treatment for pca. the latest technology can indeed be the best.

  • Damiano Beltrami

    Recover soon, we’ll meet in class!

  • Steve Gorelick

    Jeff: For a whole host of reasons, I am not sure until reading this post that I truly appreciated what benefits a linked transparent world could bring. But having lived through a prostate biopsy and ending up ok, reading this is a revealtion of what we can offer each other of we even slightly alter some of our traditional closely held notions of privacy. To read this is to feel a kinship that as I lived my ordeal a year ago, I never had.

    But this raises the larger example of what this has to say about how and why people make the leap to new media, transparency, digital tools, etc. And that point is that it really doesn’t matter what people say or the feelings and opinions they express about this new world. Because, again and again I have seen that, regardless of what people say, when the situation is such that the advantages are clear, people make the jump quite apart from any previous bitching or moaning.

    The New York Times, for example, can have had all the sincere doubts they wanted about the place of YouTube and Twitter in news coverage. But last summer, when iran blew up, all bets were off. They seemed to see almost immediately how the new “amateur” technologies could be a avaluable resource, could –judiciously edited — flesh out and not cheapen coverage.

    And I, who used to make merciless fun of Twitter and other tools that enabled people to tell me that they were on their way to the fridge, pretty quickly discovered the comfort and solidarity to be had when someone else opens up.

    I guess the point is that it might not be be necessary to wait too impatiently for people to jump on the bandwagon. In fact, there’s nothing wrong with being a Luddite. The day comes when you see that there are simply too many benefits to transparency and to jettisoning Ludditry!

    To your good health, Jeff.


    • Thanks Steve. And, yes, it’s about seeing the need and benefit. That’s what we’re trying to teach our students: to look at new tools and see the journalistic opportunities they present, to start there.

      In this case, there were personal benefits. I learned them before with an earlier ailment (afib) and that taught me there was no choice in this case. It was good for me and, I hoped, good for others (see other gratifying comments here). I argued in my column about transparency that when we pool this information/knowledge/experience, it’s good for society and thus all of us.

      The question I then deal with is: what’s the step too far? I don’t want to bring others into my glass house (my wife and kids). I don’t want to be an exhibitionist. I don’t want to play for sympathy (well, not too much). Privacy is no longer the line. What is?

  • Dan Buttry

    Thanks for the article. I had this surgery in June. You gave me lots of laughs at the memories. I’m doing great. My Dad died of prostate cancer at my age 30 years ago, so I know how blessed I am. Modesty goes out the window, but with kind medical staff, and in my case a wonderful wife, getting rid of the cancer was a no-brainer. I’ve got no regrets. I’m just glad the robot was named Da Vinci and not C3PO!

    • Thanks Dan. We’re brothers of the robot. I hope you’ve, uh, learned how to do old things in new ways. I’m still learning.

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  • John Evans

    Wow. This was the one post I thought you’d never make. This was the 800 lb gorilla I was talking about regarding this issue and, considering that reports are coming out that a lot of prostate cancer found will probably never metastasize (I realize that your family history said otherwise), your openness is vital to help check any possible greed on the part of doctors who might prescribe expensive surgery without men fully realizing what the side effects would be like to live with.

    I had a bulged cervical disk 10 years ago and swimming eventually cured that completely. Swimming was the prescription and the treatment for me.

    But I figured that out for myself, no thanks to US doctors.

    One doctor in Connecticut told me (I was only 30) that he should do an $11000 operation where he would take a bit of bone out of my hip and, after scraping out my disk between the 5th and 6th vertebrae, insert the bone chip.

    The quack knew it would cost him about $1000 in marginal cost + $4000 in malpractice insurance (guarded by the documents I would have had to sign). That was a $6000 profit for an afternoon – Doing that regularly would help him retire and play tennis young.

    But I would have probably been permanently injured by that operation. No tennis for me if I had helped him play tennis.

    An aggressive swimming program cured me entirely. My original disc is still there, healthy as ever and not bulging at all.

    While your c was probably extremely serious due to your father’s experience, I am reading more and more about how lots of c wouldn’t metastasize for 50 years, giving men in their 50s plenty of time to continue a sex life well into their 80s – and maybe then think about an operation like that.

    So I am deeply concerned about greed and “I better recommend surgery so I don’t get sued if this metastasizes” mentality causing doctors to advise men to voluntarily get (possibly) castrated when not necessary. There are surely some doctors out there who want to be sure they have a full schedule of $10,000 profit windfalls for each morning and afternoon using the robot they invested in (with some doctors having invested in an early retirement). The soaring stock price of that robot company gives me mixed feelings (I know such technology is needed of course and should be rewarded and advanced).

    Next, if you get the chance and you can write about it, please write an article about how these surgeries fit in with the Health Care debate and what options Veterans will have.

  • John Evans

    Woops. I commented on the wrong post. The above was supposed to be for the latest post you made

  • George Ferreira

    Hello All. I found this article today and I think it’s great…all of the comments….I was just diagnosed with pca, GLEASON SCORE 8. I am at a point now where the more info I have from the folks that have gone is the greater for me to make a decision as to what treatment is best for me. But , I have to say I have to make it a pleasure to meet DA Vinci in the 21st century….Best wishes to all of you.