Dear Camden,

Today is April 26^th, 2020, and in a few days, I will meet with my urologist to go over my latest numbers. April is on my rotation of months when I have the joy of seeing my medical team and going over my most recent test results. We have a little discussion about what is going on and talk about where we are in the big picture of things. The process is repeated every three months. Joy…joy.

I normally do not look forward to those months. I had tried to mix in some fun activities that I would look forward to doing to try to make April less depressing. But since I had to cancel a fishing trip with Dave and Steve, and I was not able to drive up to KC to spend a week with you as was originally planned I have not had any activities to take my mind off of April. Damn Virus!

In the past I noticed that as I would get closer to my tri-monthly visits that my anxiety would increase. That does not happen so much anymore.

I feel that I have finally realized that I cannot control those damn numbers so why get so worked up about them. No matter what happens I know what the plan is. It is my plan. My medical team might come up with some new ideas and I will listen. Yes, I will listen.

My tests were done two weeks ago, and the results are available. All I need to do is call them or look it up on the patient portal. I have not done either. I do not plan at the present to learn the results. I will see the doctor soon, and I know what is going to happen. The PSA number will either be up, or it will be down. Now if it is up the important question becomes by how much.

Camden, Gaga has asked me about the test results. I think she is a little anxious. She is normally as cool as the other side of the pillow, as Stewart Scott would say.

I have tried when I can to reduce her anxiety as well as your momma’s, your Aunt Amy’s, and Uncle Justin’s.

I have tried, but sometimes it does not work out.   She tries to be at my appointments, so I am not able to distort things. I am not able to minimize reality.

Minimizing reality is done by many people for different reasons. I am often trying to soften reality. Now I can do that. I hate it when someone tries to do it to me. It is the worst when the doctors try to minimize reality or avoid it altogether. That pisses me off.  I have heard too many times something like “why don’t we see how things go and we can discuss that next time.” I want to discuss it now.

Let me take a moment to talk about my last visit with my urologist to show you what I mean.

On January 16^th Erin posted my last essay talking about Brutus. I saw the doctor on January 17^th. Of course, my PSA number was up, but not as great of an increase as in the past. I had some hope.

We talked about my new number and I told the doctor that since the growth rate had slowed down that must mean that things were getting better.

He told me it did not mean that at all. He said that once he put all the numbers in the computer that it would be worse than it looked. Damn! Shit! Fuck!

He then went all mathematician on me. Talking about linear progressions or some shit like that. I tuned him out. I did not want to hear what he was saying. I asked him not to put the numbers in the computer. I told him that I did not want to know what that machine was going to tell me. I was serious.

He did not listen. He must have thought that I was kidding. He must have figured that I am the one who always wants to know everything. I am the one who challenges him with my digging. I am the one that makes them say what they really would not like to talk about. I am the one who wants to deal with reality. Not today doc.

Prostate Specific Antigen Doubling Time (PSADT) is an important number for someone like me to know. Months ago, when the doctor said that my numbers were increasing so fast that we might need to do something soon. He never mentioned PSADT. No one ever talked to me about PSADT. I discovered its importance on my own a long time ago.

So, on my next visit when he brought up the rate of growth, I started to talk to him about the DT. I told him that the tests were showing that my doubling time was less than three months. I told him that I understood that was bad. We talked a little about DT.

He realized that I understood why he was concerned. He was not going to need to explain it to me. Why we had not talked about it before I did not understand.

He told me that it looked like my DT could be a little under three months or a little over. He did not have the computer with him to run all the numbers. That was okay, because I have every single number branded in my brain, and every three months the number has more than doubled. I did not need a computer to tell me that my DT was less than three months.

At that moment in his office I really did not want the computer to tell me the DT. I wanted to walk out of there knowing that at least this time it had slowed down.

He put the numbers into his machine, and he announced that the DT was 3.7 months. I was sitting about two feet from him. He was looking at his computer on a small desk against the wall. My chair back was against the wall, so I was facing his opposite direction, but far enough back to look him in the face.

He then crossed his arms and continued to stare at the computer. He was not looking at me. After crossing his arms, he said, “That is a very fast doubling time.”

He sounded concerned. I could not have that Camden, Gaga was in the room. I did not want her hearing this. I did not want her upset. It was time to attempt to minimize reality. I had to jump into action. Okay, maybe not jump. I am sixty years old you know.

I then told the doctor that a 3.7 month doubling time was not that bad. I was thinking that the DT was worse than that because the doc forgot to put one of the test results into the computer. I knew that because all the numbers you remember are branded in my brain. I was not going to tell him. It was a bad number. So, for now we go with the 3.7.

Camden as soon as I got my minimizing statement out Gaga said, “Kevin, that number is terrible.”

This minimizing shit was not working. I could see that I was going to have to go big. I then said, “Well look at the bright side, at least I am not dead.”

That appeared not to be the right thing to say. Neither Gaga or the doc smiled or laughed. I realized that this was a very tough room. I should probably try my new material out somewhere else before dropping it on this audience. Oh well, I appear in this office every three months. Maybe next time I will have some better material.

I sensed that I needed to try another angle. I then turned to the doc and started talking about how the cancer must have slowed since the number had not doubled this time. “The doubling time will continue to increase, right Doc? The cancer is going to slow down, right?”

I was needing his help here. Gaga has cried before on our way home from a doctor’s visit. I really was trying to avoid that. The doctor was not much help.

The doctor did not say a word. I knew he heard me. I was freaking two feet away. He started typing on the computer showing no emotion. He did not comment on or answer my question. Damn! You would think that he was running for political office.

His silence answered my question. Allow me to interpret his silence:

He does not know. No one knows.

Camden the cancer world is full of uncertainty. Brutus could slow down. He might speed up. He could slow down and then speed up. No one knows. The doctor was not going to comment. He did not want to be put into a position where tomorrow he might have to explain why the things he said yesterday did not happen today. I get that.

I still needed to change the way this appointment was going. I was trying to figure out what to do next, because my strategery was not working. Then it came to me Camden. I needed to change the subject. That is what I did, and it worked.

I moved away from talking about my DT and Brutus. I have many other things to talk to the good doctor about. Hell, I have had three surgeries, radiation, all kinds of poisons pumped into my body and physical therapy to try to stop pissing in my pants. My body is a mess. Damn!

In the past we have talked about surgeries that might be able to fix what the past surgeries and treatments have broken. A kind of Humpty Dumpty approach. Hell, after physically therapy I still piss my pants. I have not wanted to have surgery to fix that, but I also never want to do another damn Kegel. So, at that moment in his office I sensed it was a good time to revisit the surgery topic.

My mission was accomplished. We moved completely away from talking about Brutus. There were no tears on the drive home.

We talked about fixing my body and he gave me some pamphlets. I am not sure where I put them. I have not yet read them, but they were good strategery at the time.

I probably ought to read those before I see him on Wednesday the 29^th. But I think I will do that later because it is now 1:51 A.M. on the 27^th. Time for bed.

I have physical therapy for my back in the morning. It turns out that my back problems I mentioned in my last essay are due to a couple of discs going bad in my lower back and not related to Brutus. That is good news.

Hopefully, we will have more good news in a few days. I hope to hear that my PSADT is increasing. Where we have been is dangerous. Bad things happen too men at my present DT speed.

These tri-monthly tests for now are a reality that I must live with. Probably forever. I am trying to adapt, and live with this reality, but it is hard. I try to pretend that they do not matter. But they do. They have a great impact on how I am going to live my life. They even provide insight into how long I am going to live. Et tu, Brute?

On Wednesday, the sun will be shining, and it will be a great day for more good news.

What if the news is not good? Well I have a couple of days to come up with a new strategy to minimize reality.

Remember I can do that. You cannot.

FaceTime you soon Camden. Love you.

Papa