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
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.
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.