Games of chance

SAM SMITH, 2002 – A new prostate cancer study confirms what many have learned on their own: the disease is one of the better crap shoots going. Your editor has some interest in this matter since come December it will be ten years since he was diagnosed with prostate cancer. I had surgery the following spring.

I was not totally unprepared, thanks to having worked with Julius Hobson, one of the country’s most underrated civil rights leaders. Between 1960 and 1964, Julius Hobson ran more than 80 picket lines on approximately 120 retail stores in downtown DC, resulting in employment for some 5,000 blacks. In 1967, Julius Hobson won, after a long and very lonely court battle that left him deeply in debt, a suit that outlawed the existing rigid school track system, teacher segregation, and differential distribution of books and supplies.

Hobson was also a statistician with a well honed inclination towards the rational. In the early 1970s he came down with multiple myeloma. A testimonial evening brought out 2,000 friends, enemies, and observers of Hobson including ex-student and still apostle Stokely Carmichael. Hobson was there at what he described his “wake,” sitting in a lounge chair and smoking a cigar that helped quell the nausea created by the drugs he was taking. Joan Baez sang “Swing Low, Sweet Chariot”, and Stokely Carmichael quoted Nkrumah: “Revolutions are made by men who think as men of action and act as men of thought,” His teacher mother, up from Alabama, ended a powerful speech with the benediction, “Go, son, go,” which brought the audience to its feet.

And then Julius went home, went into remission, won a seat on the city council and lived for a number of more years. I wasn’t as surprised as I might have been because I recalled, early in his disease, Julius had dispatched family members to the Library of Congress to find every article and book on the subject. Before it was over there were few people who knew as much about multiple myeloma as Julius did.

So when I was told I had prostate cancer, I went straight to my computer and began extracting – from distant sources and with unfamiliar protocols (for in the early 90s I had access only to the Internet and not the Web) – every article I could find.

I made a flow chart that listed the risks and advantages of each of the various treatments, which led me to conclude that in my case surgery was the best option. I told my doctor about the chart. He had discovered the cancer but he had also gone to the University of Virginia and a combination of medical and cultural caution led him to say, “Oh, you shouldn’t have done that. I don’t think even doctors should do that.”

On the other hand my urologist, Nick Constantinople, studied my chart, suggested a few corrections and then asked for a copy of the revised version. He knew, as I did by that point, that it wasn’t just about medicine but about the odds. And while doctors know medicine, they are not necessarily good gamblers.

Besides, a few years earlier I had already probed the limits of medical knowledge after injuring my back while weightlifting. Even after going to the physician for the Washington Capitals and with weekly visits to a sports medicine clinic, eight months later I was still spending half the day working on the floor for relief. I finally recovered thanks to the non-medical magic of an Alexander technique practitioner.

During those months I would occasionally think: so this is what it was like in the 19th century before everyone expected the doctor to have all the answers. In both my experiences, I had felt oddly in charge of my maladies. Like deciding whether to hold them or fold them.

In the end, I was happy with my choice because I didn’t have to worry about some axis of evil in my body in the years to come. Of course, prostate cancer, like breast cancer, might not be such a mystery if we spent more time and money investigating possible environmental factors. But in the meanwhile, during an era when government is eliminating our right to think for ourselves, medicine at least still leaves us with a few choices, even if the odds are not in our favor. As Damon Runyon put it, “Life is six to five against.”

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