At age sixty-six I may look as much as ten to fifteen years younger than my age. I have a full head of hair with virtually no gray hair. I barely have any wrinkles. Despite a bit of plumpness in the midsection, I do not look all that different than when I was in my twenties or thirties. I still play basketball regularly, and I still jump as high as I could forty-five years ago—not very high. Some of these youthful twists may be tied in with my genes, but most of these twists come from this fountain of youth.
I am also starting my tenth adolescence—nine of them since age forty-four, over a twenty-two year period. Groundhog Day personified. Who the hell is writing this screenplay, this trajectory of a crazy life? The gods have set it up so that in one of these puberties I will eventually get it right.
In my first experience of adolescence, puberty started at twelve, in 1960. It was a good enough set of teenage years, not necessarily filled with the teen angst that many people describe. I was adept in school, played sports, had good friends, and hung out with my fellow high schoolers at the local ice cream shop. A few of us would head up to the New York border where the drinking age was eighteen instead of Connecticut’s twenty-one. We hung out at a bar in Port Chester (a town we called Sin City) that must have paid off the police. We never showed IDs and were able to drink at sixteen. I did not have high alcohol tolerance so I had a few close calls with intoxication and made a fool of myself more than once, but no big deal.
I never got laid in junior high or high school. I was too shy; I hadn’t developed any good pickup lines; I fumbled around when it came to girls.
But there was no need to replay this phase of my life, especially nine more times. Especially since replaying it meant going through childhood again. See, to reach puberty nine more times, you have no choice but to go back to prepuberty nine more times.
Prepuberty sucks. You lose the hair on your chest. Your skin becomes soft and smooth. You lose your muscle mass. You become, once again, a ninety-eight-pound weakling. If you are a baseball pitcher, you lose at least twenty miles per hour on your fastball. If you are a golfer, your two-hundred-yard tee shots become seventy-five-yard dribblers. If you are a tennis player, you begin to rely on drop shots. Ah, the fountain of youth.
It is the exact opposite of the steroid age in sports. Those of us with metastatic prostate cancer have had our ’droids taken away. The most flattering comment for real athletes: He is a man among boys. No, I am a boy among men.
Admittedly, with the coming of these past nine puberties and adolescences, I do get laid right away. No fumbling around, no need for pickup lines, no concerns about shyness. Almost a biblical kind of adolescence: You reach puberty, you are married at the start of this adolescence, and you can start getting laid as soon as you reach puberty. No arranged marriage—but you do need a willing partner who is somehow willing to go through her partner’s nine trips through prepuberty. But no need for masturbation, no need for onanism when you rereach this adolescence. Biblical strictures from twenty-seven hundred years ago make sense in this one and only context.
A fluorescent adolescence—a flowering now nine extra times with the re-advent of testosterone, with the re-advent of puberty. I still have not gotten prepuberty and puberty right despite my ten tries. I hope to keep going, though, through an eleventh, a twelfth . . . Maybe I’ll get it right the next time. Hope springs eternal. A pubertal spring brings hope.
By November 1992, my PSA had risen to 9.9. It was time to act. I quickly headed to Vancouver to meet with Nicholas Bruchovsky. Another Gerald-Murphy-like moment, but this time I actually met the man, the expert. Not unlike Gerald Murphy, he renewed my faith in man, in physicians, in myself. Sure, Nick had self-interest at heart just like the rest of us, but his compassion and genuine interest in me and my predicament came through immediately. He could relate fully to my desire to protect my testicles and avoid any permanent castration. And he had a plan.
We started on two drugs not typically used in the United States—first a tiny dose of diethylstilbesterol, or DES, the notorious fertility drug that was used in the 1940s. It had allowed women to get pregnant and have babies, but no one knew at the time that it would have horrific effects on the offspring and on future generations—not unlike radiation. These DES babies eventually developed vaginal cancers and infertility in adulthood.
Yet one person’s poison is another person’s salvation. No need for me to worry about vaginal cancer or infertility; I already had my own pelvic cancer and infertility.
The second drug was cyproterone acetate, developed as a steroidal anti-androgen by a German pharmaceutical company but not available in the United States. The company had gotten a rapid routine approval for the drug in Canada and Europe but encountered a more cumbersome and intimidating approval process in the United States. The hell with it, they decided—and men in the US have therefore been denied a reasonable and well-tolerated medication over the past thirty years.
After three or four weeks, we replaced the DES with an injectable medication called goserelin (Zoladex) that blocks the release of gonadotrophin in the hypothalamus and pituitary and in turn blocks the production of testosterone in the testicles. In Canada it was do-it-yourself. One of Nick’s colleagues had me watch a video to learn how to inject the Zolodex subcutaneously, just under the skin, into my abdomen on a monthly—eventually every three-month—basis. No financial waste in the Canadian system, no need to go to the doctor for a simple injection.
“At some point the cyproterone acetate will not work quite as well as it does now. The cancer will develop some resistance to its effects,” Nick noted. “But we have a bunch of nonsteroidal anti-androgens waiting in the wings—flutamide and nilutamide and a new one called bicalutamide.” The same drug the Sloan-Kettering guy had touted a year or two earlier.
“We’ll use these drugs sequentially over the years, and you should be able to get some good mileage out of each of these medications.”
Although we were talking about castration—making my big cojones into smaller and smaller cojones—Nick’s conversational style was reassuring and gave me the sense that this literal emasculation would be manageable, especially since it was temporary and reversible.
This gentle and kindly prince of a man I began to picture, rightly or wrongly, as a patrician White Russian who seemed still genuinely confused and troubled by the Russian Revolution seventy-five years earlier. Who are these guys, Marx and Lenin and Trotsky? Where did they come from? Why are they and their ideas screwing up a stable monarchy and a stable country? Couldn’t we have gone the way of Britain, limiting the power of the kings and queens while creating a new power structure, without some violent revolution? Okay, so we won’t call Catherine “great” anymore. And then he found himself practicing medicine in Canada, in a socialist medical care system. Was he simply trying to understand and master the events of 1917?
But money did not appear to be a motivating force. He just wanted to get the word out about the wisdom of this intermittent androgen blockade, about less being more, or less at least being the same and no worse than more. All this from the backwaters of Vancouver, from where chauvinist Americans dismiss any new notions and findings.
And Nick implicitly wanted to ask the right questions of his patients who had metastatic prostate cancer. How important is it for you to continue to be a sexual being? How awful will it be for you to be permanently asexual? How much pride and dignity will you lose with a permanent castration? In essence, is sex important to you?
Some men and women would reluctantly acknowledge that sex is not important to them. Take out those damn testicles, take out those damn ovaries, take out all those damn hormones produced by those testicles and ovaries. Who needs them? We all have different hopes and dreams, different priorities, different agendas, different yearnings and longings, different fears and anxieties.
Some patients and their physicians may not be able to live with the ambiguity and uncertainty of a nonpermanent castration. Let’s go with the accepted
protocol. Let’s not ask too many questions. Let’s not try anything new and offbeat. Just choose: your testicles or your life.
With Nick I would not have to choose and face this Hobbesian choice. I could have my cake and eat it too; I could have my life and beat it too. Keep my nutsack—temporarily out of commission—and keep my life. All my efforts to recover from the ravages of prostate cancer treatments would not be in vain. The hyperbaric oxygen, the acupuncture, the return of erections and sexual revelry—no, all was not lost.
Within twelve days after initiating the chemical castration in December 1992, my PSA dropped from 9.9 to 2.7. Seven months later the PSA was down to undetectable levels, less than 0.06. In the face of castration I was at least getting remarkable results. The prostate cancer was temporarily in retreat.
I was also in retreat—a castrated retreat. No sex life, no fantasy life, no double entendres. Yes, I have found the fountain of youth. I am young after my time. I am not aging in the same way as my peers, many of whom are old before their time. And my youth is not wasted while being young—I have found ways to waste my youth while growing old.
Yet I do not grow old . . . I do not grow old, I shall not wear my trousers rolled. This fountain of youth, though, is a piece of crap, a piece of trash, not all that it is cracked up to be. Better to age and die in the usual and customary ways. This fountain of youth—F’get about it.
Yes, I have heard the mermaids sing, each to each. Yet I can only hope they will return to sing to me. They are not singing to me now. I have indeed seen the moment of my greatness flicker. A new kind of metaphorical death. How do I cope? What does this all mean? What is the meaning of life, the meaning of death, the meaning of love and sex? How do I cope even with a temporary castration?
Can I maintain a healthy mind in the face of castration? And can healthy mind and castration be used in the same sentence?
CHAPTER 14
Redemption, of Sorts
There lives more faith in honest doubt,
Believe me, than in half the creeds.
Alfred, Lord Tennyson
I am for religion against religions.
Victor Hugo, Les Miserables
Faith is to believe what we do not see; and the reward of this faith is to see what we believe.
St. Augustine
I believe in the sun even when it is not shining.
I believe in love even when not feeling it.
I believe in God even when God appears to be silent.
Inscription on a cellar wall in Cologne in 1943
I can believe anything, provided it is incredible.
Oscar Wilde, The Picture of Dorian Gray
Imagine the kind of punitive gods we can create in thinking about prostate cancer. If HIV became a punitive symbol in the late twentieth century for the profligate sexuality of the 1960s, imagine the field day we can have with prostate cancer, especially when it hits young men like myself.
Can the gods create any better scourge against human sexuality? Let’s see what we sadistic fuckers up in the heavens can do to those cocksure heathens down below. Let’s create erectile dysfunction and impotence and loss of jism and loss of fertility and loss of libido all in one fell swoop. Let’s create a disease that will force the caregivers to lance and slash pelvises, then burn and radiate the base of penises. Then for good measure we’ll see if the caregivers might realize—hey, we’ll give a couple of scientists the Nobel Prize for discovering this intervention—that cutting off a guy’s balls might give the guy a few more years to live. Surgical hell, radiation hell, castration hell. Even Dante could not have imagined these circles of hell.
Nothing cures societal licentiousness and salaciousness like prostate cancer. Better than HIV disease. A right-winger’s wet dream, a religious zealot’s wet dream. No wanton sex, no pregnancies—no sleeping around and no creation of single-parent families and no unwanted children and no potential abortions. No male homosexuality—or male heterosexuality, for that matter. No male sexual assaults or rapes. Prostate cancer for every adult male, and all our social ills are solved.
I do not want any part of these social cures and these gods. No need for guilt-inducing gods, no need for terrorizing gods, no need for vengeful gods—gods that, with society’s crazy projections, are punishing people because of, say, the supposed depravity of an era, of a nation, of a particular ethnic group, of a particular sexual orientation.
Studies show that highly religious people too often give up on treatment for a potentially deadly condition. No point in trying to regain one’s health: I have screwed up; I have sinned; I have gotten what I deserve. My fate is sealed. All I can do is accept the punishment I deserve. A helplessness and hopelessness that take on a life of their own.
Yet I wanted and needed gods—gods that were comforting and reassuring. I have had enough terror with my castration anxiety. Enough. As the atheist and physicist Freeman Dyson has pointed out, most atheists do not understand and appreciate the “anguish” of religious believers—an anguish that cannot help but induce some kind of religious belief. I was a walking embodiment of this anguish.
History is filled with tales of presumably sane people undergoing religious conversions in the face of life-threatening illnesses. The writer Walker Percy converted to Catholicism after his confrontation with tuberculosis as a young man. The singer-songwriter Cat Stevens, who had a remarkable run of creativity in his teens and early twenties, converted to Islam after almost drowning, which followed shortly on the heels of a diagnosis of tuberculosis. Leo Tolstoy went through a major religious phase in his later years as he faced his fragility and mortality. There may be something wrong with a picture of any sentient human being facing his fragility and death without some kind of change in perspective, without some kind of attitude adjustment, without some kind of spiritual awakening, whatever that notion means.
Human beings have been around for approximately 150,000 years, of which most of these millennia have been filled with human aggressiveness and impulsivity and violence. Religions were essential in binding us together as tight-knit groups, to face challenges and battles—wars to the death—with other equally tight-knit religious groups.
But I was not in a battle with any human enemy. I was locked in battle with prostate cancer and the forces that were gradually taking more and more of my pelvic functioning away from me.
In the ancient religions of our hunter-gatherer ancestors, long before humans became settled ten thousand years ago (with the stabilization of the earth’s climate), people felt they were communicating with the supernatural world through dreams and trances. Through these séances and hypnotic reveries, they asked their gods for practical help in their survival—good hunting and good weather, successful healing and health, triumphant outcomes in battles and wars.
Trances appear to have been a central feature of any of the ancient religions that predated the major monotheistic religions. As Nicholas Wade notes in The Faith Instinct, “In a survey of almost five hundred small-scale societies, the anthropologist Erika Bourguignon found that 90 percent had rites in which regular trance states occurred, data for the other 10 percent being insufficient to know whether or not this was the case.”
In contrast, the modern religions, developing in settled societies with the advent of agriculture and the domestication of animals and other food sources, have produced a priestly class of rabbis and imams and priests and ministers that direct people toward what happens after we die, to the after-death, to the afterlife. These modern monotheistic religions have been essential in organizing and controlling a larger and more settled society—to keep people in line via threats of what can happen in the afterlife if they do not follow the religion’s and society’s tenets.
It may not be too simplistic to say that the co-religionists in an ancient hunting and gathering society attempted to achieve salvation and survival in the real world, whereas the followers of modern religions have been more focused on survival and salvation in the illusory after
life.
No surprise then that my focus was much more in line with the religions of the ancient world. Mesmer continued to be my guide—mesmerism and the trance, as defined by Gilbert Rouget as a “transcendence of one’s normal self, as a liberation resulting from the intensification of a mental or physical disposition, in short, as an exaltation . . . of the self.” I harked back to the root for “enthusiasm,” the Greek word enthousiasmos meaning “being possessed by a god.”
I will speak in tongues; I will sing and dance the night away; I will muster heavenly amounts of enthusiasm; I will become possessed by the gods. A cult of one, a religion of one.
Perhaps I will pray to the old Greek and Roman gods of fertility and love and sexuality, Eros and Cupid. I desperately and enthusiastically needed them—to sustain my sexuality, to maintain my capacity for love, to regain my fertility. Who the hell pushed them out of favor?
Who the hell and what the hell determines for us what kind of gods we believe in and pray to? It seems all predetermined simply by the family we happen to be born into. If we are born into a Muslim family, we become Muslim; Christian family, then a Christian; Jewish, Hindu, Buddhist, you name it. If we are born into an atheistic family, we will probably become atheists ourselves. We may assert some modest control by leaving certain sects and joining other sects within that same religion. If we marry into another religion, we may feel some pressure to leave our religion and join the one of our spouse. But our family of origin asserts enormous control. At the height of our suggestibility and hypnotizability, we get inculcated with a belief system that is almost impossible to shake. Training in the religion of our fathers and mothers, in the religion of our grandfathers and grandmothers, takes hold of us and will not let go.
Yet the notion of a god or gods is merely a projection, a Rohrschach card that can be interpreted in myriad ways—with no right or wrong answer—an inkblot that represents our own projections and assumptions and experiences and schooling, along with all our hopes and fears and yearnings.
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