MACLEANS – Running from Cancer: One in seven men in Canada will face prostate cancer. Almost none of them will ever talk about it. A strikingly candid account from singer, songwriter and author Dan Hill.
On the evening of Oct. 20, 2011, I was backstage, 30 minutes from performing a two-hour concert in Cambridge, Ont., when my cell went off. Caller ID ﬂashed the name of the world-renowned urologist to whom I’d been referred: Dr. Robert Nam. Since when, in this world of wildly overbooked doctors, did elite specialists call patients in the evening? Guitar in one hand, cellphone in the other, I shuddered, ﬂashing back on the two visits I’d had with Dr. Nam over as many weeks.
It had been under unrelenting pressure from my wife and family doctor that I’d ﬁrst agreed to visit Dr. Nam, at Toronto’s Sunnybrook hospital. My most recent blood test showed my PSA (prostate speciﬁc antigen) to be slightly high: a possible indicator of cancer. Knowing that PSA tests are replete with false positives, I regarded my result as a false alarm. I’d even cancelled a biopsy my former urologist had scheduled two years earlier, so certain was I of my infallibility.
What was I thinking? Cancer had recently claimed the lives of two of my closest friends: Paul Quarrington, a Governor General Award-winning author and musician, and the celebrated Juno-feted soul singer Haydain Neale. Haydain had lived on my street, and I’d visited him almost daily. Paul, my lifelong friend, had collaborated with me on a song about staring down a fatal cancer diagnosis. Rarely a day went by where I didn’t talk to Paul. I’d witnessed the blow-by-blow ravages of cancer at close range, as it viciously took down two people I loved.
Thoughts of Paul and Haydain haunted me as I valet-parked my car at Sunnybrook. Valet parking at a hospital? What next, I thought, a Morton’s steak house next to the palliative care unit?
Indeed, the sensation of sweeping luxury followed me through the hospital’s revolving doors and onto its polished granite ﬂoors. Certainly, the charm of Sunnybrook is that it feels, at ﬁrst glance, more like a cathedral than a medical institution. Its expansive atrium boasts a sky-lit ceiling that appears to brush against the clouds. With sunlight illuminating the mounted names of donors, Sunnybrook virtually sparkles. However, the welcoming gleam of its architectural splendour quickly faded, as I recalled where I was headed.
The urology wing was buried deep on the bottom ﬂoor, accessed through a labyrinth of twisting hallways. Entering the waiting room, I was immediately struck by the disquieting, almost cruel contrast between the receptionists (all female, young and vivacious) and the patients (male, aging, grim and exhausted).
Mercifully, within minutes of my scheduled appointment, I was sitting in Dr. Nam’s office. Before he even had a chance to read my medical history, I blurted out my greatest, really my only, concern. “Dr. Nam, I’m not getting a rectal today, am I? This is, well, um, our ﬁrst meeting.” My ﬂailing attempt at humour caused the doctor’s mouth to pucker into a bemused half-smile.
“No, Mr. Hill, you can relax. I don’t need to examine you, I have all the information I need.” Emboldened, my second question sounded unintentionally like a challenge: “Okay, based on my PSA, what are my chances of having cancer?”
Dr. Nam was already typing my stats into a computer, lost in a ﬁxed concentration that called to mind a 12-year-old entranced by his Xbox. I imagined my body, replete with its risk factors—being black, diabetic and an occasional binge drinker—as a mere algorithm being solved. Caught between staring at the doctor’s face and the ﬂashing computer monitor, I almost missed his answer. Or maybe I just didn’t want to hear it.
“You have a 12 to 23 per cent chance of having aggressive prostate cancer.”
Aggressive. Prostate. Cancer. Never had I heard three such vile words strung together. Of the three, “aggressive” cut the deepest. Hard as I tried to spin a negative 23 per cent into its positive—a 77 per cent chance of being healthy—the numbers and probabilities started to blur together. I was vaguely aware of a disembodied voice, mine, asking: “When can I have a biopsy?”
“Are you sure that’s what you want?” Dr. Nam cautioned. “Many people with your odds pass up the biopsy. It’s an invasive procedure and with your diabetes, chances of infection and fever are quite high.”
I insisted on the biopsy, trying to push back the sickening realization that had I allowed the biopsy to take place two years ago, any cancer would have been caught early.
“The actual procedure only takes about 10 minutes,” explained Dr. Nam. “You’ll experience quite a bit of bleeding afterwards—in your urine, your rectum, and possibly in your semen?”
My semen? That seemed like the ultimate indignity.
Before leaving Sunnybrook, I checked in with Dr. Nam’s assistant, Jen, to book my biopsy. “We do biopsies on Mondays,” she said, brightly. “What date and time would you like?” Feeling as though I were signing up for a yoga class, I booked early afternoon the following Monday.
I’d swaggered into the hospital feeling ﬁt and cocky. I left feeling bruised and ancient.
In Canada, one in seven men will develop prostate cancer. Although over 85 per cent of prostate cancer is curable if detected and treated early, each year 4,100 people out of 25,500 diagnosed with this disease will die. Not only is it the most common cancer for men, it’s largely asymptomatic: for every man diagnosed with prostate cancer, there are several men who have no idea that their prostate may well be a ticking time bomb.
Some studies have indicated that close to 30 per cent of men in their thirties unknowingly have the beginnings of prostate cancer, but they will most likely die with it, rather than from it. Nevertheless, underestimating the potential lethality of this cancer is like nuzzling up to a domesticated wild animal. Nine times out of 10 the lion may purr, but that tenth time, he will chew you up alive.
Men, unlike women, are reluctant to share their health challenges with anyone. This is especially true with men that have this disease, as it strikes right to the core of their masculinity. (One “minor” side effect of living a prostate-free life: no more ejaculations during orgasm. What, pray tell, would that feel, or not feel like? Devouring chocolate cake without icing? Slurping ice cream without the cream?) In a world where virility, in all its permutations, is regarded as a man’s greatest virtue, prostate cancer feels but one step removed from serving out your life as a castrato in a perpetually prepubescent choir.
As I reclaimed my car, the valet attendant trumpeted, “Dan Hill, holy s–t, you’re my hero! I’ll only charge you half price.” After insisting on paying in full and tipping him for recognizing me (this NEVER happens), the young man looked into my face, about to say thank you. Instead, he caught himself. “Mr. Hill, is something wrong?”
“I think I may have cancer.”
There. I’d done it; uttered the “c” word to an absolute stranger. The young man stepped back, as if I might be contagious.
Oct. 17, 2011
Dr. Nam enters the biopsy room all smiles. I’m naked from the waist down, wearing one of those ﬂimsy pale blue hospital gowns—two gowns actually, tied around me in opposite directions. In my anxious state I’ve tangled up the gowns so badly that my genitals keep popping out like contrary hand puppets. I am on the examination table.
“Mr. Hill, can you curl up your knees closer to your chest?”
“What, no foreplay?” I quip. Jesus, could I be any more exposed and powerless? Trembling despite the warmth of the room, I confess, “Look, I’m a total wimp. I can only endure this procedure by carrying on a conversation. About anything other than what you’re actually doing to me. The talking will relax me.”
“Of course, Mr. Hill. We call that ‘verbal anaesthesia.’ And so far you’re doing just ﬁne.”
“But we haven’t started yet.” My words are already coming in broken gasps.
“Most men are squeamish but pretend to be tough, and they’re the ones who faint before the procedure even gets started.”
“I’m going to level with you, Dr. Nam,” I croak. “I’m a singer and most of the noise bellowing out of my supercharged vocal chords will come in the form of profanities.”
“Swear all you like, but try not to scream. You’ll frighten the other patients.”
I take the pillow and stuff it into my mouth.
“That’s right,” Dr. Nam says, as if remembering something, “someone mentioned that you’re a singer. We should discuss you doing a fundraiser for prostate cancer.” His request is followed by a playful laugh. Is he having me on to lighten the mood?
“Sure,” I blubber, astonished by his bedside jocularity. Whatever: given my compromised position, had Dr. Nam asked me to prance into Toronto Mayor Rob Ford’s ofﬁce trilling Tiptoe Through the Tulips, I would have consented.
An ultrasound probe is slowly nudged inside the rectum to transmit an image of the prostate onto a screen. This serves as a map that Dr. Nam can use to locate and remove small tissues, or cores, from my prostate—12 in total.
“Don’t move. Try to relax your muscles,” Dr. Nam says. I force my hamstrings, tighter than a 100-m hurdler’s, to decompress.
The probe removed, the doctor reaches for his arsenal of needles. “I’m going to give you extra freezing,” he says cheerfully, like I’ve won a prize for good behaviour.
“How much pain are you feeling?” This after I feel the slight ping of the ﬁrst needle.
“Arrgh—!*@#.” My teeth-indented, drool-sopped pillow looks like a pack of wild coyotes have mistaken it for a poodle.
“Okay, I’m going to start the biopsy now.”
Every removal of a tissue sample is preceded by what sounds like the snapping of an oversized stapler.
“How . . . do . . . you . . . like . . . your . . . job?” As the words hiccup out of me, I wonder how anyone can tolerate a job with scenes like this one.
“I love my job. Curing people of cancer. Preventing cancer. This is what I live for.”
The way Dr. Nam says this, neither earnest nor pompous, but more out of wonderment, leaves me strangely moved.
Oct. 20, 2011
Three and a half days later, at 7.30 p.m., I get the call backstage. “Thirty minutes before showtime,” a canned announcement blares, all but drowning out the tentative voice on my cellphone.
“Hi Dan, it’s Dr. Nam. I don’t usually tell patients their diagnosis over the phone. But your results took a little longer because of special staining, I didn’t want to leave you hanging.”
Special staining? Yikes.
“Dan, because of your unique travel schedule I felt it only right to reach out to you. When can you come into my ofﬁce?”
An ofﬁce invite. That’s it. Bad news.
“I can’t make it in,” I answer. “ I’m out on the road for a week. Better that I hear the news now.”
There is a frightening silence on the other end of the phone, followed by a non-sequitur so peculiar I nearly drop the guitar I am cradling.
“Have I told you, Dan, that I’m reading your book I Am My Father’s Son and loving it? I feel as though I know your whole family now.”
I’m not feeling particularly bullish about this conversation. I play along, frenetically searching for clues in the tone of Dr. Nam’s voice, trying to predict what the verdict is. I’m of two minds: 1) He’s buttering me up to soften the blow. 2) No, if I had cancer he’d get straight to the point.
“Twenty minutes before showtime,” crackles an announcement over the speakers backstage. I’d forgotten where I was.
“Dan, you have cancer. The severity is measured on something called the Gleason Scale. You’re seven on the Gleason scale. If 10 is the worst and ﬁve is barely noticeable, you’re right in the middle. We have to examine your biopsy results more thoroughly before we can determine just how far the cancer has spread. I know this comes as a shock, but this is a highly treatable cancer.”
“How’s it treated?”
“Your treatment options are wide open. You and I will review your choices once we know more. There’s no need to panic and rush into a decision. Meanwhile, just keep doing what you’re doing. Live life. Above all, enjoy yourself.”
Enjoy myself? I feel ﬂattened, squashed, like a bug on a windshield. How could my body betray me like this?
“Dan? Dan? Are you still there?”
“Dr. Nam, I’ll take the surgery. The sooner the better. I want this thing out.”
“Are you sure?” Dr. Nam is asking. “You’ll have a far greater chance of incontinence, especially considering your diabetes. The incontinence would make it difﬁcult for you to perform.”
What I don’t know at this moment is that if the cancer has spread beyond my prostate, to my lymph nodes and then my bones, surgery will not be an option. It will be too late.
“Dan, you’re on stage in ﬁve minutes,” the manager of the hall interrupts.
“Dr. Nam, I’ll take the surgery.” I’d gone robotic, my words stuck on repeat.
“Okay. We’ll book you for early December.”
I make two calls. One is to Larry; I have to tell my brother that his chances of getting prostate cancer have just doubled. His palpable concern leaves me more upset. He abruptly stops everything to drive an hour to be with me. Then I call my wife, Bev.
“Oh no, no, no, I can’t believe this. You’re the healthiest person I know.” Her voice sounds so broken and small it smashes my heart. “I should be with you. I have to be with you.” She’s sobbing.
“Bad idea,” I snap. “You’d have to borrow a car, drive all the way here in the dark and then return home in the middle of the night.”
“Don’t do that thing you always do,” Bev pleads. “You’re already starting to freeze me out—like you always do when there’s a crisis.”
It would take me a while to realize that prostate cancer wasn’t just about me. It was just as much about Bev.
I wander on stage in a fugue state and spend the next two hours singing as though I might never sing again. I don’t remember a single detail about the performance.
I also make it through the next two shows without a hitch. It is the 22 hours in between that I am a mess. Everything—remembering where I’d left my wallet, my cellphone, my hotel and car keys, packing my suitcase for the next town—represents an impossible task. My usual self-discipline decimated, I gorge on fast food—what difference does it make now?—sprinting to the hotel bar after each show, jonesing for that blottoed numbness I hadn’t felt since my father’s last days eight years earlier.
To be away from my wife leaves me feeling the strangest kind of lonely. How can I explain to her, to anyone, that I need the aloneness of the road to rage unwatched at my cancer? This disease feels personal, more vindictive than a heart attack or stroke. Cancer is calculating, a monster deliberately festering in your body, like some deranged alien, for one simple reason. To kill you.
More than anything, it is the unwavering love of my family that keeps me from falling apart. The nighttime is the worst. Sometimes, when the sadness and fury almost paralyze me, I silently press my head ﬁrmly against Bev’s shoulder while she watches The Bachelor, till the warmth of her body, bit by bit, soothes me. I lose track of the times she wakes me in the throes of a nightmare, my limbs thrashing, each dream suffused with scenes of me dying.
“No, Dan, you won’t die.”
“How do you know?”
She holds my perspiring face in her delicate hands and ﬁnds a way to talk me out of my hysteria.
“I won’t let you. Dr. Nam won’t let you. Most of all, you won’t let you. Besides, you’re too obsessive and proud to die.” No matter how many times Bev tells me this, I have to hear her say it, over and over again, night after night. And still, though I never mention this to her, part of me feels irrevocably broken.
Oct. 24, 2011
Mid-morning it comes. An email detailing the pathology of my biopsy for metastases. (I’d had to give Dr. Nam permission to map it out in an email.) Leaping out in bold letters are three words. NEGATIVE FOR MALIGNANCY. Knowing that cancer might still be lurking beneath the radar, Dr. Nam books a MRI for Dec. 8.
While I still regard the surgical removal of my prostate as my safest option, I decide to explore radiation as another possibility. Realistically, options are determined by several factors: age, health, ﬁtness level and, most critically, the aggressiveness of your cancer. Maddeningly, everyone from specialists to patients to expert authors has a different opinion as to the right course to take.
In my case, the ﬁrst advantage of a radical prostatectomy is that the rate and spread of the cancer can be accurately analyzed. And, with my prostate removed, I will not have to worry about the cancer returning. While radiation therapy is less invasive with fewer side effects, questions remain. Might a cancer recur? In ﬁve years? 10 years? Never? Whatever the answer, if it does recur, the prostate will have been too damaged by radiation to be removed by surgery and properly evaluated. Lastly, radiation wipes out healthy tissue along with the cancerous, and I am not crazy about the temporary damage my body would endure.
Still, radiation will leave me far less vulnerable to the possibilities of impotence and incontinence. I am faced with an impossible choice: quality of life (meaning, essentially, quality of sex life) versus duration of life.
“How hard are your erections?”
The ﬁrst nurse speaks with a strong Pakistani accent, leaving me to think that I’d misheard her. If only.
Dr. Nam set up a meeting so I could discuss radiation options with a radiation oncologist, but neglected to tell me that beforehand, I’d be in for a no-nonsense Q & A by two thirtysomething nurses that leaves me feeling as though I am auditioning for a porn ﬂick. “Compared to when you were 18, how hard are your erections now?” the nurse qualiﬁes, her unflinching stare causing me to squirm in my chair.
I confess that I can’t recall the varying quality of my erections over the span of my sex life.
“Do you ever have problems penetrating due to a weak erection?”
This from the second nurse, whose South African accent exudes a quaint properness that leaves me feeling vaguely guilty of something.
“Do you ever have problems maintaining an erection during intercourse?”
And, before I can answer: “Are your orgasms ever painful?”
A painful orgasm? Inconceivable, I think. I play it safe, sticking to one-word answers (no, no, no). I grudgingly admire the pluck, the unﬂappability of these nurses as they calmly scribble notes.
The doctor appears, calls me into his ofﬁce and gets right down to business. “Brachytherapy [high-dose radiation therapy] is your best bet,” he advises. “Odds are you’ll survive the radiation with an undiminished sex drive. Furthermore, there’s almost zilch chance of incontinence and no one I’ve carried out this procedure on has died during my radiation therapy.”
Well, that comes as a relief. I ask him which procedure, of the two, he would choose.
“If I was a ﬁt 57-year-old man, with no symptoms, I would deﬁnitely opt for HDRT. As for the chance that your cancer has spread to your bones, there’s no way you’d be running 10 miles a day on concrete without any back, knee, hip or joint pain.”
There is another consideration. Radical prostatectomy means at best 48 hours in a hospital. And I am in for at least a six-week recovery period, with close to half that time being catheterized. With HDRT, I’d be in and out of the hospital in four hours, catheter-free, conceivably able to resume my life and work without a hitch.
Later that week, I am back in Dr. Nam’s ofﬁce, more torn than ever over which course to take.
“Look at it this way, Dan,” Dr. Nam tells me, as we discuss my likely side effects following a radical prostatectomy. “As a 57-year-old diabetic it’s remarkable you’re still sexually active. Chances are, you’re going to be facing, sooner than later, erectile dysfunction. And hey, worse comes to worst you can give yourself a needle at the base of your penis containing a triple mix of drugs and wham . . . ”—grinning ﬁendishly, Dr.Nam shoots up his right forearm as if he was about to spike a volleyball—“you’ll be as hard as a 17-year-old.”
This makes for fascinating science, but really, erection injections as foreplay followed by sex-as-practice to regain full function post-surgery sounds about as titillating as a three-way with Bill O’Reilly and Newt Gingrich.
Late November, 2011
The need to feel in control of my health causes me to turn my running, cycling and weight workouts into a full-time job. By the end of November I am in the best shape of my life. One day while I am running, a cyclist blows by me, then brakes and asks: “Hey Dan, when’s your surgery?”
So the word is spreading. Or had he seen me crying? Why was I crying? Because, as my heart rate rose to 160 bpm, something clicked. Get the damned cancer out through surgery. It’s not just about you and your oh-so-sacred erections. You have a family to consider. As I walk up the street to my house, I realize my tears came not from sadness, but from a huge measure of relief at ﬁnally making a decision.
Dec. 12, 2011
Four days had passed since my MRI and, unable to bear the suspense much longer, I email Dr. Nam and his assistant Jen.
Jen, efﬁcient and friendly, immediately replies:
“Hi Dan, They did come back. I left it with Dr. Nam to look at today. I will let you know what he says tomorrow. Have a good night.”
That night I give Bev a ﬂow chart of all my songs, mapping out who published what, and when each schedule of royalty payment is expected. How could I have published over a thousand songs and never bothered to break down such a convoluted royalty trail, in the event that I predeceased my wife? That I need another task, something to distract me, is not lost on Bev.
Dec. 13, 2011
My ﬁrst email of the day is from Dr. Nam: “Below is the ofﬁcial report. No evidence of spread. Great news.”
Rather than being overjoyed, I simply find something new to worry about. Facing surgery the following morning, I panic. Less than 24 hours before my surgery, I send Dr. Nam this Hail-Mary email: “Given that based on the MRI cancer is showing in only one place, is there any reason to reconsider surgery on the 14th?”
Blessed with indefatigable patience, Dr. Nam writes back: “The purpose of the MRI is to determine whether there is spread. It doesn’t change the situation of the prostate itself. There are other areas within the prostate that the MRI has not picked up (too small). Need to stay the course.”
Despite constant reassurance from everyone, I can’t shake the fear that I won’t make it through surgery. Irrational? Certainly. But it still seems irrational that I had cancer in the ﬁrst place.
Dec, 14, 2011
It’s 6 a.m. and I’m in the pre-surgery waiting room. Dazed and mildly incoherent from no solid food for the last 30 hours, no ﬂuids for the last four and an antibiotic so big and powerful I can barely swallow, much less tolerate it, I am no longer terriﬁed of dying on the operating table. I have no energy left to feel much of anything. I hear my name called by the front desk. The woman behind the glass hands me back my hospital card. The simple task of writing my birthdate down demands more hand-eye coordination than I can muster. I glance down at my illegible signature and it’s a dead ringer for Dad’s unreadable scrawl, once he’d lost all semblance of ﬁne motor control. Because my brother Larry is also here, a lot of this harkens back to our father’s ﬁnal days in the hospital. I see the love and concern on my brother’s face and wonder if he’s seeing me, the older brother, as a jarring echo of our waiting periods with Dad, before his amputations.
Minutes before I’m escorted into surgery, I’m instructed to give Bev my wedding ring, something that hasn’t left my ﬁnger for 30 years.
There’s a theatrical air to an operating room, as though some spectacle is about to take place.
“What kind of music would you like to hear, Dan?” asks Dr. Nam, like we’re at a dance club and he’s the DJ.
“Brahms,” I answer, knowing Dr. Nam has a love of classical music.
“Done,” he says with remarkable cheer. The last thing I remember is Dr. Nam pronouncing to the room, “We can’t do surgery on Dan Hill without music.”
When I wake I don’t know where I am. Who I am. But I don’t care, I feel incredible, as though I’m ﬂoating around in a drug-infused heaven. I’m ﬂying through space, and the voices I’m hearing blend together like a choir led by Sam Cooke and Aretha Franklin.
“Dan? Do you know where you are?” It’s Dr. Nam. I look up and see his face glowing. “Your surgery was a textbook success. No cancer spreading and only minimal bleeding.” I hear cheering.
“Thank you for saving my life,” I whisper, then I fall into a gloriously deep sleep.
Within days of my surgery, a pathology of my prostate reveals that only 10 per cent was cancerous and that it was completely conﬁned within the prostate gland. Of my catheter, which leaves me feeling impaled for 17 days, the less said the better. The day after it is removed, I start running. I don’t recommend this—intense activities are discouraged for at least six weeks post-surgery—but it is my way of saying “f–k you, cancer.” I’m still here, kicking and screaming and sucking up life in huge, hungry gasps. As for sex?
A few weeks ago, Dr. Nam advised me to “get back in the saddle the sooner the better.”
“But what about the studies showing it sometimes takes years to get blood ﬂow going again?” I asked, shocked given our pre-op discussions.
“If you can already run 10 miles, then you have great circulation and you’re ready to try making love. Practise with your wife every day, and even if it’s not working, practice will speed recovery.”
Hedging my bets, I asked Dr. Nam to set me up with the doctor who specialized in “erection injections.”
“Certainly,” Dr. Nam said, “ I’ll arrange a meeting with you and Dr. Cox.”
Dr. Cox? Sometimes, even while staring down mortality, you just have to laugh your ass off.