A Salamander's Tale

by Paul Steinberg

  The doctors were not only showering me with longevity statistics, they were also quite clear that my chances of regaining my potency were virtually zero. Too many insults to the pelvis, to the prostate bed. First surgery, then radiation—my pelvis would never recover; no one in history had ever been able to recover from that level of insult.

  The lowest of low blows: The rules of boxing do not allow boxers to punch their opponent below the belt. Just in case their opponent hits them below the belt, they wear an athletic cup, a hard plastic shell to protect their testicles, their family jewels, their privates. No problem if their opponent smashes them repeatedly in the head, or anywhere else in the upper body including the arms, the chest, the abdomen, and even the kidneys.

  Professional boxers do not even wear headgear to protect their brains. So, when women complain that men have their brains in their penises, they are more than half-right. We men protect our family jewels more than we protect our actual brains.

  In May of 1985, I lost my fucking brain. It was now a non-fucking brain. The family jewels had been stomped on—no more fertility, no more sexual fantasies, no more sense of a sexual prowess, whatever that term means.

  Athletic prowess, academic prowess, interpersonal prowess: All of these prowesses are valuable, but they do not hold a candle to sexual prowess. What does it mean to be a man, an adult male, lacking in any kind of sexual prowess? Confidence is shattered, expectations are shattered. Hopes and dreams, the pipe dreams, the fantasied, if unreal, sexual conquests—gone, kaput, crushed. No sexual prowess translates into no proudness. No self-assuredness, no brashness, no resoluteness to fight to live—instead, fragility and vulnerability.

  The irony, the irony. The horror, the horror. Just a few years before, I had been teaching an honors course at the University of Maryland called “The Inner Life: The Nature of Dreams and Passions.” The course, an excuse for me as a psychiatrist on campus to teach a few of my favorite Philip Roth novels including The Professor of Desire, Portnoy’s Complaint, and The Breast, with a little John Updike and Franz Kafka thrown in for good measure, had examined our inner lives and our yearnings—our longings, especially unfilled longings, which inevitably become sexualized when we reach puberty. We looked at our dreams, our nightly reflections of our uncensored yearnings, what Sigmund Freud or his translators called “wish fulfillment.”

  Now a few short years later, I had become a parody of the professor of desire. A man incapable of dreams or desires or passions.

  The final straw came in June of 1985, as I was sitting in our family room reading a review of a new Roth novel in the Sunday New York Times and realized that even the act of reading—with our imaginations aroused as we fill in the unstated blanks on the page—tied in with the penis and sex for us. The playful inner life, the playful spirit, the playful conversations, filled with playful remarks and double entendres, die with the death of the pelvis. Human touch loses a part of its meaning. My partner, my lover—Helen—no longer had to guess whether there was any hidden meaning in a simple touch, in the holding of hands, or in an inadvertent bumping into each other while cooking together in the kitchen—a bump which under other circumstances might have led to some kisses and hugs, some looks longingly into each other’s eyes that would later lead to further pleasures even if we had to wait a few hours until the kids were asleep.

  As I sat in my home simply reading a book review, I could not even enjoy anything smacking of sexual playfulness. My floodgates had opened. A trivial activity, reading a newspaper, finally made me aware of how profound it is to experience the death of one’s pelvis.

  And it is all so private, this experience, this despair, this loss. We can talk about other losses rather readily, but not so the loss of our privates.

  The word most frequently associated with the bedroom: privacy. Whatever happens in the bedroom stays in the bedroom. The gods have programmed us as a species to suddenly develop a self-consciousness, a super-awareness of our privates as soon as we reach puberty. When we suddenly have a capacity to create a new offspring—to get pregnant or make someone pregnant—we get a bit skittish about this new power, these new impulses. We cover our breasts, our vaginas, our penises obsessively, carefully, maniacally.

  Even children who have grown up with nudist parents—kids who are quite inured to nudity—become highly self-conscious about their privates when they reach puberty and adolescence. No more nudity for me, thank you very much, they say. A peculiar kind of rebellion: I want my clothes on, not off.

  Men who are dealing with prostate cancer, men who have faced surgery and radiation and castration suddenly clam up as well. We cover up our privates even more maniacally than ever before.

  A classic example is Anthony Sattilaro who in 1982 wrote, with the help of Tom Monte, one of the earliest and most inspirational stories about his personal experiences with prostate cancer, Recalled by Life, a book I turned to in 1984 as I faced my own traumas. Satillaro, a physician specializing in anesthesiology, had been diagnosed with metastatic prostate cancer. By the time it was first found at the age of forty-seven, the cancer had already spread widely to his bones. Told that he had barely months to live and in hopeless despair, he unexpectedly happened upon a hitchhiker who changed his life. In a wondrous turnaround, Sattilaro took the hitchhiker’s advice to try a macrobiotic diet. This diet in combination with surgical castration—the conventional treatment for metastatic prostate cancer at the time—led to the complete disappearance of visible disease. Satillaro lived for twelve more years, most of those years disease-free, before dying of the cancer.

  Looking for inspiration in early 1985, with my pelvis on the verge of death, I called Satillaro. His book had focused on the near-miraculous effects of eating macrobiotically; and in his second book, he had focused on specific recipes for eating macrobiotically.

  How had he dealt with castration, with the end of his sex life, with the end of double entendres and sexual playfulness? I had not faced castration yet—surgery and radiation had been bad enough—but how had he figured out how to cope? His otherwise fine book had not touched on the effects of castration, its psychological and physical impact.

  “Can I ask you how you’ve coped with castration?” I tentatively asked, after the initial pleasantries, after some talk about our common bonds as physicians and prostate cancer sufferers. Not the usual question one asks in an initial conversation, but he was clearly supportive and cordial from the outset.

  “Not so well,” he noted. “I’ve spent hours upon hours in (psychiatric) analysis trying to cope with it. This is not easy stuff.”

  But not a word of these struggles in his two books. Our privates stay private especially when they have been surgically removed.

  We have had The Vagina Monologues, and we are long overdue for The Penis Monologues. No better place than to start here.

  CHAPTER 2

  Come: Going, Going, Gone

  “Hey, don’t knock masturbation. It’s sex with someone I love.”

  Woody Allen, Annie Hall

  Like most men, I used to be a scumbag. Now I can proudly and definitively, yet sadly, say that I am no longer a scumbag.

  Facing impotence after prostate surgery at the age of thirty-six is a profound blow—a blow to one’s confidence, a blow to one’s sense of self, a blow to the joys of orgasm, a blow to the joys of animal spirits and passions. Yet, four to five weeks after surgery, I was feeling pretty, pretty good. I was beginning to feel my first pelvic stirrings, and I was even seeing the beginnings of erections.

  The nerve-sparing procedure in taking out my prostate had worked. Instead of blindly and aggressively cutting through all the nerve supply in the pelvis to frantically pull out the prostate—the nerve supply to the pelvis is enormous, second only to the brain—the surgeons had spared virtually all of the nerves on one side of it. Theoretically this sparing of nerve damage would be enough to allow me to regain potency. And theory was turning into reality.

  Everything seemed to be
in sync. A friend loaned us a VCR, a new piece of technology that had just been developed in the previous year or two, and Helen and I were able to watch recently released movies at home for the first time.

  I could begin to move back into denial. I am still a twenty-something, a teenager even, not in my mid-thirties, with the large passions and drives of adolescence and young adulthood still going strong. Prostate cancer, prostate surgery, future radiation to the prostate bed: A thing of the past—the surgeons got it all, they said—and not a thing of the future. I am watching Fast Times at Ridgemont High on the VCR, and I briefly return to my youthful innocence, unclouded by disease and death. Helen is comforting and encouraging and passionate. My erections are coming. A grand slam, a hole in one, a three-point shot from half court. Thank you, Helen, thank you, surgeons. The comeback kid is coming.

  Except there was no ejaculant. A grand slam, and now bam. No come, no scum, no jism. No muss and no fuss, as Helen quickly reminded me. Where was it? Where did it go? I hardly knew ye.

  The surprise of puberty: No more dry humping. A wet sticky mess comes, of course, with puberty. Unless we talk with our friends, a conversation I never had as a twelve-year-old, we have to figure out what to do with this glutinous goo. Do we masturbate into a wad of tissues (yes)—but then what do we do with this wad? Doesn’t it look a bit strange to suddenly be willing to empty your own small pail of garbage every day? Doesn’t it look a bit peculiar to be getting a new box of tissues for the night table every other day? Doesn’t it look weird to make periodic trips to the trash cans outside and to take those trash cans to the front of the house twice a week for garbage collection—a chore I was never actually asked to do? How weird is it to suddenly be using the washing machine and dryer a couple of times a week, to deal with sticky underwear and sheets?

  I never thought to masturbate into the toilet. It was much more comfortable in the privacy—again, the privacy and the self-consciousness and embarrassment of early adolescence—of my bedroom. I never thought to use that night’s yet-uncooked liver or brisket—we were big meat eaters—as a receptacle for my newfound fertile syrup. A new kind of meat tenderizer, a newfangled gravy enhancer. I never thought to use an apple pie either, to bring out the juices of the apples, to make the crust as moist as possible.

  And just as I am letting go of my puzzlement and my embarrassment, and just as I am enjoying the pleasures of this lush and rich and fruitful mess, it’s gone. I am just as puzzled as I was at twelve. Where did it go? I had just had a modest erection, I had just had sex with Helen—something I thought might never happen ever again—I had just had an orgasm. But no ejaculant, no cum. An ejaculation without ejaculant. What the hell?

  I call my internist frantically. I am experiencing orgasmic joy, I tell him; but I am completely confused. No cum came. Nothing, nada. Is there something further wrong with my penis, my pelvis, my prostate-bed?

  A highly experienced physician, a few years older than myself, he was as confused as I was. “I’ve never heard of this. None of my patients have indicated this kind of problem post-prostatectomy previously. I’ll look into it.”

  This was November, 1984, six weeks after surgery. Men then did not talk about sexual dysfunction, orgasms, erectile dysfunction (ED). ED was not an acronym that was anywhere close to the horizon.

  I called the urological surgeon in Manhattan the next day. “Of course you’re not going to have any ejaculant, any secretions. Your seminal vesicles, which produce seminal fluid, have been removed along with your prostate. The spermatic cord has been cut in the process of removing your prostate; and now the sperm, whatever is left of it, empties into your bladder. It’s all retrograde ejaculation, whatever minimal fluids are left.”

  It has all been turned upside down.

  Okay, but why didn’t anyone warn me about this? It’s too private. Sex stays in the bedroom, not in the surgical suite, not in the doctor’s office. We’ve saved your life. What more do you want? We’ll talk to you about survival statistics, but why should we talk to you about sexual side effects? Just deal with it. Get over it.

  A new coming-of-age movie or novel for the prostate cancer generation: Where are the up-to-date renderings of Portnoy’s Complaint and American Pie? How does one learn the new versions of the birds and the bees—the coming-of-age and the going-of-age? Quite possibly the confusions of puberty and adolescence are not nearly as funny as the confusions that come with prostate cancer—a new kind of self-consciousness, a new kind of stumbling and blundering and floundering.

  No more human stain, no more creamy mess that keeps our species ripening and evolving. I was realizing that prostate cancer and all of its treatments affect everything that makes us human, that assures survival of us as a species.

  CHAPTER 3

  My Head and My Doctors’ Heads Up My Butt

  “I had the experience . . . of sitting on an endoscopic device (electromagnetic resonance, or some such truc). Inside me a balloon was inflated with water; a TV screen was turned towards me and there I saw my own prostate gland, my own seminal vesicles, my own bladder, with the fluid in it resembling a little pond with a still surface. The prostate entered the picture like the top half of an egg. . .. So when my father said I had my head up my ass, this was the vision that made me laugh. What would one see there?”

  —Saul Bellow, More Die of Heartbreak

  It was not a pretty picture, what the physicians felt and saw there. I was only thirty-five years old. With his fingers up my butt, my internist told me at my yearly physical exam that my prostate was unusually enlarged for someone my age. The head of urology at a local teaching hospital told me that the size of the prostate was indeed worrisome but that I was too young to have prostate cancer. “It must be something unusual, like tuberculosis or a tubercular abscess.”

  If it was not cancer, I said to myself, I could put off having a metal tube put up my penis and urethra. I would just watch and wait. A little knowledge is a dangerous thing for me as a physician. The textbooks had told me in medical school that, generally, people die with prostate cancer, not of prostate cancer. A false assumption, particularly for someone in his thirties who may have an especially aggressive form of the cancer.

  Oh, if only I had had the disease of Kafka and Rilke. Tuberculosis a century ago was filled with all sorts of indignities and death. Now in the developed Western world, tuberculosis is highly treatable with antibiotics, and virtually no one dies of it unless one has an immune deficiency. No untreatable wretched coughing, no horrifying gobs of blood in the sputum, no wasting away with ghastly weight loss, no leprous isolation in an arid sanitarium.

  Instead, the gods had created a new source of indignity for the late twentieth century and early twenty-first century. Those sadistic and warped gods had given up on the lungs and moved further down to the penis. So, we men could now breathe easier, but we might not be able to make love, have orgasms, and reproduce.

  It starts with the male pelvic exam and only gets worse. No fun, the rectal exam with a physician’s fingers up one’s ass, but certainly no worse, and perhaps a bit better, than the pelvic exam for women. We men at least do not have to put our legs in stirrups but simply have to assume the doggy position.

  The beginning of the end for testosterone-driven male dominance: If I ever was an alpha male, that rank no longer applies. Just stay in that doggy position and take your lumps.

  Those lumps indeed took some disturbing new forms.

  I was playing tennis with a friend on one of the two public tennis courts behind our home in northwest Washington, DC. The city had been kind enough to convert two full-court basketball courts into two tennis courts and had moved the basketball courts to another part of the park sitting behind our house. I was playing badly. My backhand had betrayed me. I was spraying my backhand shots into the net and beyond the baseline, anywhere but inside the court.

  After one particularly awful shot, I had enough. Like a piqued teenager, I angrily ran over to the chain-linked fen
ce at the back of the court and hurriedly hit a backhand into the fence. Ostensibly I was just practicing my backhand, trying to get it right for the next point. But the fence was only five feet away. The ball ricocheted weirdly and swiftly and hit me in the left testicle. A tennis ball into my balls.

  No big deal, I said to myself. I finished out my tennis game. The pain was intense, but I had been through this before. I was a catcher in baseball throughout my high school years; and, when stupid enough not to wear an athletic cup, I had occasionally been hit in the balls. But the bruising and pain had resolved within a few days. Not so this time.

  The pain was unremitting. I began to wonder whether my enlarged, previously asymptomatic, prostate was a more serious concern than the urologist in Washington, DC had indicated. What the hell was going on?

  A bit more desperate, I made my way up to a teaching hospital in upper Manhattan—still in pain several weeks after hitting the tennis ball into my testicle. Through a friend of the family, I had been given an entrée into seeing a good young urologist at this teaching hospital, who felt my prostate and did not like what he felt. No reassurances this time that it was something benign. He took charge: “You are not going anywhere. You are not leaving the grounds of this medical center without an immediate and thorough workup. Prostate cancer absolutely has to be considered and ruled out.” Thanks, I truly needed that.

  Sure enough, first the ultrasound showing a large misshapen tumor that looked like anything but a benign prostate enlargement. The biopsy the next day confirmed the diagnosis. The pathology slides showed a potentially aggressive cancer, with cells that were undifferentiated, cells that were primitive and unevolved, that were dividing rapidly and refusing to die, that could readily spread throughout my body and kill me.