Ignorance
When I was 59, an office based geoscientist, I had a BMI of about 24. I liked to maintain my fitness by long distance hill walking (though not fell running). I enjoyed good food and didn’t smoke or drink alcohol. So I was surprised when my PSA was found to have jumped to 9.7 in the sixteen months between two blood tests.
Denial
How could I have cancer without any symptoms?
It took three PSA tests over three months for me to accept that my PSA readings indicated the need for a biopsy. This was after rectal examinations had indicated nothing unusual. I truly had no symptoms I recognised. The PSA test was the first evidence of a potential problem.
After that first 9.7, the next was 9.5 six weeks later. I wondered about mild infections and thought that I’d go onto monitor mode if my next PSA was less than 8. Eight was my own cutoff, an arbitrary value I chose after reading about PSA and talking with several professionals. I thought we’d simply switch from annual to quarterly blood tests, just be sure.
Six weeks later the PSA was 8.03. Fair enough, I thought, that’s more than 8. Let’s do the TRUS biopsy and prove I don’t have cancer.
Biopsy
The TRUS biopsy went very well. I was discharged within a few hours and slept well that night. Mind you, I had incredibly vivid dreams and woke up feeling very tired. And slightly warm.
I had felt very tired when I woke up so I sat on the couch reading for a couple of hours. I was getting tireder and began wondering about a lagging after-effect from the general anaesthetic. That was when the infection kicked in.
I’d never had sepsis before and I was glad that I was at home on the couch when it struck. I was even luckier that there were two other adults in the house at the time.
I locked up with rigors and their onset was almost instantaneous though I’m not a reliable witness because I may have been dosing. I was really tired and feeling chill when here was a sudden attack of severe shivering. Then I felt really, really cold. After that, my legs and arms went into cramps and spasms and thereafter, my memories are increasingly hazy. They say we don’t recall pain very well. I suggest there may be a threshold beyond which we can’t forget some of the pain because I still recall wishing my thigh muscles were could be disconnected from me.
The hospital advised my wife that she could get me to A&E faster than an ambulance could fetch me. I still have horrible memories of the hideous discomfort from every bump on the six kilometre journey, bumps that couldn’t be avoided by her most careful driving. Speed bumps may be great for traffic management but they can be tortuous during medical emergencies.
To rework a terrible old medical cliché, the biopsy operation had been a complete success but unfortunately, in this case, the patient had to be re-admitted to hospital the next day.
Disaster
I was told in advance that I had around 1% chance of a TRUS biopsy infection. In fact, my chosen hospital had a track record of much less than 1%. Global averages were worse but some regions fare better. I was also told that if it happened, any infection would be a ‘full-on’ event. I should have bet on the lottery that week because my 100:1 odds came in and the infection was indeed seriously ‘full-on’.
I had an inkling of what ‘full-on’ meant because an acquaintance, an oncologist in Canada who specialises in external beam radiation therapy (EBRT), told me over dinner of his TRUS infection when he had a false positive PSA. How’s that for double irony? We had met for dinner the day after I made a biopsy appointment and this oncologist, who doesn’t have cancer, explained his awful infection to this guy who is sure his false positive will be confirmed by a simple biopsy. I was wrong.
I remember asking my urologist about infection rates as I waited for the sedative to kick in. He told me the number of prostate biopsies coducted in the hospital each week, a number that was higher than I’d have imagined, and admitted they’d had two infections so far that year. It seemed that the rate was about 0.5%. I was about help bring it back closer to 1%.
At this point, I should mention the sedative because my urologist had persuaded met to accept sedation. His argument was that I’d be more comfortable if sedated. This overcame a slight concern that arose from a general anaesthetic for a procedure a few years earlier. It had left me feeling ‘jet lagged’ for over two weeks. That had been, I think, only the second GA I’d ever had, the first being for a tonsillectomy as a toddler. However, the point of this digression is that one of my fellow patients, someone I had yet to meet, told me that his urologist sent him for a biopsy in another hospital where no sedative was offered. He was still talking about his awful biopsy five months later. [Spoiler alert. We both survived the prostate cancer and stay in touch.] Six years on, he still comments about it.
It seems that a jet-setting career has enabled me assemble an exotic collection of bacteria that included beasties resistant to normal antibiotics routinely given in the country where I live. The subsequent treatment with ‘strong’ broad spectrum antibiotics had side effects, one of the worst of which was total exhaustion.
Getting the 1% chance infection alerts you to the downsides. Maybe the scariest moment was when my urologist seemed surprised to see me upright, sensate and mentate (his words) six days into the infection. I’d been in the high dependency unit for a little over 24 hours after my blood pressure dropped off the scales of the machines they use. I recall a Russian nurse bringing in two replacements before she realised it was me, not the machines. After that I was totally relaxed. I kid you not. My pressure was so low that I wonderfully, soothingly relaxed.
When they got my blood pressure back up somehow, I became aware of new pains. My brain still cannot imagine how it could have been worse even with Torquemada himself assisting. I hear gallstones are rough but they tend not to repeat hourly over several days. And there it is again, there must be a pain threshold beyond which we can’t forget some agonies.
Three urologists visited with me in hospital after my biopsy. All had the same first name. One was surprised when I told him he was the 95th person to be within two metres of me since I entered the hospital some 48 hours earlier. Reception. Ward. HDU. Another Ward. Doctors. Nurses. Microbiologists. Phlebotomists. Cleaners. Caterers. Consultants. Day and night and weekend shifts of all of the above. I stopped counting when the third consultant became person number 114.
Diagnosis
I was lucky in one sense. The potentially fatal sepsis from the biopsy allowed me see there were much worse things than prostate cancer. The rigors had kicked in within 24 hours of the biopsy, I was rushed to hospital and I ended up in the high dependency unit that evening after my blood pressure dropped off the monitors. Then I spent a memorably miserable week in hospital before getting home under a homecare plan that included another week of IV antibiotics. And somewhere in all of this, I was told that I actually did have cancer. Damn.
That sepsis was this day six years ago.
I’m very pleased to report it had a happy ending.
Afterthought
If you wonder why you can’t visit loved ones in hospital during a pandemic, there are lots of good reasons.
‘All the king’s horses and all the king’s men
Couldn’t put Humpty together again.’
To do better than Humpty Dumpty, hospitals rely on collaboration among huge numbers of people. As I wrote, I stopped counting when the third consultant became person number 114.
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