Biting the Bullet

BY RALPH BLUM

The idea of  “biting the bullet”—enduring a painful or otherwise unpleasant situation that is seen as unavoidable—has a lot of history in the folklore of American cowboys, Indian soldiers and other embattled warriors. I found the first literary reference to the phrase in Rudyard Kipling’s 1891 novel, The Light that Failed.” As a call to courage under duress, the Kipling character advises his wavering friend, “'Bite on the bullet, old man, and don't let them think you're afraid.” By 1926, the term had moved from the battlefield to the drawing rooms of upper class England in P.G. Wodehouse’s comic novel The Inimitable Jeeves, with Bertie Wooster advising Jeeves, “Brace up and bite the bullet. I’m afraid I have bad news for you.” 

For me, the “bullet” is the decision (after almost 25 years of living with prostate cancer with only one brief excursion into hormone therapy) to give up active surveillance and undergo some form of more radical treatment. My lurking fear is that whatever treatment I choose could produce significant “collateral damage.” That’s the downside. The upside is the possibility of a cure.

This uncertainty is nothing new. Many years ago, I decided that for me, surgery was not an option. I had interviewed too many men who, after surgery, found themselves living with irreversible side-effects, or worst case scenario, on chemo and miserable when the cancer had returned. (The irony of attacking the cancer with a deadly poison was not lost on me.

Then one day, when I was doing research on the two most effective radiation options—seed implants, and intensity modulated radiation therapy (IMRT)— Mark Scholz said, “You still could go for a knockout with IMRT. It’s the best treatment choice in your case. You might want to check it out.” For “knockout” read “cure.”  And frankly, I am worn down from co-existing with prostate cancer.

So it’s time to move on. The cancer has been in the right seminal vesicle for over five years. Which to many urologists means out of the capsule, and therefore likely to be heading for my bones. Plus even though Combidex testing indicated that the lymph system was clean, that was four years ago!

What is measurably different in my situation? I can think of three things that weigh on my thinking. For a start, I am almost a quarter of a century older than when I was first diagnosed. Second, my 80 year old immune system may no longer be the potent ally it was when I began the “watchful waiting” protocol. And third—and most chilling—for no obvious reason, my PSA has just spiked from 14 to above 34.

Considering Mark’s advice, I realize that my generation is blessed to have Medicare in its undiminished form. Add to that a chunk of backup insurance offered by AARP. So for less than $500 a month, I am covered for almost any situation. Which is hugely lucky, since IMRT, the treatment on which I am about to embark, will cost the taxpayers around of $500 per treatment—of which there will be 44!

I am not looking forward to starting the treatments, but of all the four-letter words in the language, the word “cure” is most appealing one to me right now.

Time to bite the bullet.