The Brotherhood

Tom, Dick, Harry and Toby

As Good As I Once Was

Toby Keith

The Brotherhood: Tom, Dick, Harry, and Toby

Toby Keith just sang “As Good As I Once Was” as I was driving along the freeway. It hit home, and  it kicked in memories with a vengeance! The memories were of how things once were, of those things ‘they’ never tell you, and of the strange and enlightening conversations I have had with other men.  The stories are true; the names are changed. As for me, like the song says, “I ain’t as good as I once was, but I’m as good once as I ever was.”

It all started several years ago.

My wife is a cancer survivor.  She was a great patient and is still an inspiration..  She should not have survived her rare and aggressive form of cancer, but she did.  More than survived, she thrived.  So a trip to the dentist was really and truly no big deal.  On one of her regular checkups, she mentioned to our family dentist that I had been having some back pains.  She mentioned, too, that I often woke up in the night drenching wet.  “You know,” he said, “I’ve known guys who have experienced similar things – only to find that they had prostate cancer.  Maybe he should have his PSA checked.”

Never argue with a wife on a mission.  Before too long, I had my PSA checked.

On a bright July Saturday not too long after that, my wife was sitting beside the community pool in our neighborhood.  That, in itself, was a rarity.  We very seldom visited that particular pool, but our youngest son was there for a friend’s birthday party.  I had just gotten a phone call from my doctor’s office.  The tests had come back, and they were positive.  It was prostate cancer.  “Damn dentist,” I said.  And so it started. 

There were rounds of doctor visits and preparations, tests and more tests.  There were also plenty of options to consider.  Options.  When a guy is diagnosed with prostate cancer, there is a menu of choices.  Today, there are even more. To me, though, as a non-medical person on the receiving end of the explanations, this is what the options sounded like.

The first option was often something called watchful waiting.  The least invasive choice, this takes a wait-and-see approach to prostate cancer.  Prostate cancer, itself, is fairly common and often slow growing. As a result,  many, many men have prostate cancer when they die, and since many men die of something else – like old age – before the cancer gets them, watchful waiting allows men to continue with their regular lives while the damn thing slowly, slowly grows and spreads.  If it doesn’t grow too fast or spread too far, so be it. The guy lives and dies with it, but not from it.  However, he is also likely to have other “male problems” as he grows older.

A second option was radiation.  Zap the suckers.  Nuke ‘em from the outside in.  This takes time and is less of a sure thing.  But there is no cutting out or sticking in involved.

Seeds were another option.  Doctors implant radioactive seeds and the radiation kills the cancerous cells from the inside.  That is the premise.  More invasive than watchful waiting, it is also “nerve sparing”, a good thing.

Finally, there was surgery.  A radical prostatectomy.  Or the more artful da Vinci robotic method. Cut it out.  That way, the man knows that the cancerous gland is gone, out of the body.  Pretty much, anyway.  Nothing is absolute, however.  Sometimes, it takes a combination of the above, surgery and radiation, for example.  There were ranges of effectiveness, but there were no guarantees. 

That was not the only ‘but’, however.  Along with a range of effectiveness, there was also a host of issues, issues of incontinence, lowered sexual drive and an even lower sexual function, for starters.  And each of these has a range of impact. However, again, newer, nerve sparing surgical procedures and doctors with more experience can minimize the negative impacts to a large degree.

For me, there was no question.  It was going to be surgery.  I wanted the damned thing out of me, and fast.  I was less concerned with the side effects.  I was in my 50’s.  My family was complete and healthy; my wife and I were definitely not planning to add any more kids.  My doctor was recognized as one of the very best in the country for his handiwork, and based on what I was told and what I’d read, I could expect to return to almost full functionality before too long after surgery.  After some discussions around the what-ifs, my wife and I decided that surgery was the safest long-term option.

This is not a story of surgery, however.  There was a lot of excellent pre-op information and great during- and after-care resources.  The surgery went well.   I went into the hospital on a Monday and was out by Thursday, catheter bag in tow.  There was one nasty side trip back to the hospital afterwards.  A blockage, a lymphocele, which meant something was not draining – except into my swollen leg.  Not a good thing.  I went back to the hospital where a team of male technicians who told me, “This won’t hurt a bit,” as they wryly smiled and rammed a tube up into my groin.  Pain-wise, they did not know what they were talking about, and they did not become part of my new brotherhood!

Once the blockage was taken care of, I was almost back in business.  An initiation of sorts was about to begin. I bore the scars of the cuts; I carried the pee bag of public identification.  So far as I knew, I was cancer free.   That was when I began to learn things, things the doctors never tell you. That was when I began to hear from people – men – who did know what they were talking about. It was my “Welcome to the brotherhood.” 

Listen up, guys.  

First of all, I have to say that what I am about to relate is based on conversations around topics I never thought I would be having with other men, other brothers.  The stories are true; the names have been changed to protect….  They are realities.  Again, they involve things the doctors never told me.

As I was recuperating, just beginning to feel like myself again, I had a phone call from a man I still have yet to meet in person.  He was a high school classmate of my wife.  Somehow, through the wonders of social media, he had found out that I had joined the brotherhood.  A bond was borne out of the cut.  I will call him Tom, Towel Rack Tom.

“So, how you doing, Brah?” Tom asked me from 2,000 miles away.  Coming right along, I told him.  “Getting it up yet?” he asked next.  He wasted no time.  “Huh?”  “You know, Brah.  Hard yet?  Stiffies?  Boners?”  Never in my life had I had ever had anyone ask me that, let alone another man, a stranger, no less.  I realized this was something special, a brotherhood.  “Not yet,” I admitted, “still not yet.”  “No problem,” he reassured me, “it’s still early. Don’t rush it.  If you have a good doc, you’ll do fine.  Takes time.  But I gotta tell you,” he went on, “and nobody’ll ever tell you this…” And so it began. 

Tom went on to explain with great pride that, back in his prime, he was The Man.  He’d been able to have and sustain such a strong, hard erection that he could hold beach towels on his dick and walk around the room. “Damn, I was a hell of a pool boy!” he said.  Now, though, he went on, after a couple years and with help from his little blue pills, his hard on was ‘serviceable’. That was his word, serviceable. About all he could carry anymore, though, was a dry wash cloth.  On a good day.  Maybe.  “Remember: serviceable.  Critical word. They’ll never tell you that,” he said.  And so we closed that conversation.

Word spreads fast sometimes.  Tom had given me something to think about, but my good friend Dick added yet another dimension.  Not long after talking to Towel Rack, I was having a beer with Dick.  We started laughing as I recounted Tom’s story.  That’s when Dick added another bit of wisdom from the brotherhood. 

“You need to get ready for something,” he said. “What that other guy said is true, but there’s more.”  More?  “Did anybody tell you about coming dry?”  Coming dry?  I wasn’t quite sure of the context.  I said, “Um…no.”  “Didn’t think so,” Dick nodded.  “They never do.”  So he took that task on, himself.

Dick explained some basic biology.  Erections.  Orgasms.  Who’s on first.  What’s going up and what’s coming down.  Prostates and seminal fluids.  Dick went on to say that once I was ready for sexual relations, my orgasms would be different.  Different? “Yep, bottom line,” he said, “the pipes are bone dry. (No pun intended.) There’s nothing going down ‘em anymore.  No more dog-water. No more squirt and release. The faucet’s on but the pipes are dry.” He smiled and added, “No more wet spots.  No more clean up, though.”   Then with more of a giggle, “Unless, of course, you pee.”  Thank you, Dry Dick.

He went on to say that that didn’t mean that sex wouldn’t be good, that it wouldn’t feel great.  He just wanted to prepare me for the reality that it would feel different, and that it would probably take some getting used to.  He was right.  Post-prostrate orgasms are not the same as pre-op pops. Obviously, I can’t speak for all the brothers, but based on my experience, they are somewhat more difficult and take longer to achieve, but they seem to come from a deeper place in the body. They are, as a result, in some hard-to-define way, more pleasurable than the old, messy ones. Nobody had told me that before, either.

Following procedures, there are check backs.  PSA checks.  Likert scales having to do with getting up at night, getting it up at night, urine flow, sexual ‘ability’ and the like.  On a scale of 1 to 7, how’s your flow?  On a scale of 1 to 7, how serviceable is your erection?  (That word again; this time from the medical person.)    My buddy Sean told me about one of his check back visits. “So about 18 months or so into the whole process, as the doctor’s helper – the physician’s assistant – was hefting my testicles in his hand,” he said, “the guy casually asked, ‘So, how’s everything going?’”  Sean told him that, overall, things were actually pretty good.  He’d had never had to wear Depends, generally slept through the night without getting up to go, peed well, and sexual ability was OK – 4 out of 7 –  with some pharmaceutical help.  Sean did say, though, that sometimes, when he looked at himself in the mirror, it just seemed that he was looking … shriveled.  Smaller.  Less.  Then Sean told me what the doctors never had, “That damn PA guy looked me straight in the eye, and with a very ‘didn’t anyone tell you’ expression, he said to me, ‘Of course.  That’s natural.’”  The PA went on to add, “After prostate surgery, men often lose up to an inch or more off the length of their flaccid penis.”  Really?  Nobody had mentioned that bit of happy news before. He went on to explain some more of the biology to Sean, but all Sean was thinking was, “NOBODY ever mentioned THAT before!”  Sean tried to tell himself, “Who cares?”  He thought, “Nobody ever sees me naked.  Nobody looks at me and thinks: Stud.  Nobody cares how big and manly I look.”  By this time in our conversation, we were both laughing pretty hard. Nervously, but hard. (I think I peed a little.) He closed, though, with one last comment, “As a guy who’s always been more a grower than a shower, I just gotta say, “Who cares how I look!?  Damn it, I do!”  Nobody else ever told me that.

I was beginning to think that there ought to be a manual for the brothers.

One night at a high school football game, I ran into my buddy Harry.  Harry, a fairly new brother, had opted for the seed implant.  Since that was not what I had done, we began to share some experiences.  Apparently, the seed thing also has its impact of sexual ability.  Harry told me a story of a recent trip he had taken to an ED clinic.  He had seen an ad on television for a remarkable new medication for men with erectile dysfunction.  “No need to wait for the pill to kick in; just a drop under the tongue,” it promised.  “That’s for me!” Harry thought.  The little blue pills were sort of working, but like those of us who had had surgery, they didn’t fully make up for lost ability.  The TV ad mentioned a free visit, an exam, and a trial offer.  It all sounded good.  Harry worked nights, his wife worked days; he had motive and opportunity.

The clinic welcomed his visit and directed him to an exam room.  A “doctor” came in shortly after.  “Drop our drawers,” the doc told Harry.  Harry did.   “Drop your shorts.”  He did.  “What’s going on?” he was asked.  “Not too much,” he answered sheepishly.  “Saw your ad and thought maybe your under the tongue pills might help.”  “Well, let’s just see!” the doctor said.  Simple as that.

Rather than receiving an under the tongue sample as the TV ad had suggested, the doctor hefted Harry and gave him a shot of the medication in the end of his penis.  “That was weird,” Harry told me a little more softly than the rest of our conversation.  The doctor left the room while Harry waited.

“It didn’t take long,” he said.  Within 10 minutes, Harry had an erection that would have made Towel Rack Tom jealous.  Before too long, the doctor returned.  He flicked and tweaked Harry’s penis a bit, apparently pleased with the reaction.  Boing.  Flick.  Diddle. Yep! Hard, all right.  To hear Harry tell this story near the end zone during our sons’ game was hilarious!

Harry and the doctor talked under-the-tongue pills.  They talked costs.  For all its promise, the magic med was going to be way too expensive and not covered by Harry’s insurance. He and the doctor started to close the conversation. Harry pulled up his shorts and began pulling on his pants.  His erection was popping out through the fly of his boxers.  He dressed around it.  Harry began to wonder when his heroic hard-on would die down.  It was already becoming a hard-on from hell.  He told me that he snuck out of the office, back to his car and headed toward home.  The damn thing never went away.  The dream-come-true was becoming a nightmare. We laughed. “What’d you do?” I asked.  He and I were barely able to contain ourselves.  Since his wife was not going to be home for several hours, he took a cold shower and did whatever it took to get his penis back to normal. 

Nobody had ever told me a story like that before – or since.

Time passed and conversations took other turns.  Towel Rack Tom, Dry Dick, Short Sean and Hard Harry all prepared me for some things I needed to know.  Then there was Bob, Bob the Banker.  Bob told me about a conversation he was going to have with his son, his 13 year old son.  As it turned out, prostate cancer seemed to run in Bob’s family.  His dad had had it, although, back in the day, nobody realized it.  His dad’s ‘problems’ were blamed on the aging process.  When you got old, you have a harder time holding your pee.  When you get old, you have a harder time getting it up.  When you get old, who cares.  It wasn’t until his dad had been diagnosed with something else that his prostate cancer was diagnosed.  Bob’s older brother had been diagnosed earlier than their dad.  He’d had his prostate removed; he was doing well. 

Now, Bob was getting ready to have “the talk” with his son.  But his talk was going to be a bit different from the usual father-son-birds-and-bees talk.  Bob fully intended to spend some time talking about salting a few away for a rainy day.  Sperm, that is.  He was going to talk to the boy about sperm banks.  “You never know,” he said.  “The boy’s got it in his genes.  He might want to put a few aside while he’s still got ‘em in his jeans.”  Nobody had ever prepared me for that possibility.

But one night, after a few beers, another friend, Frank, and I reached a whole new level of sharing.  Yet another conversation I had never thought I’d have with a buddy.  Frank admitted, frankly, that he had learned to fake his orgasms.   He felt terrible about that.  He felt bad because his wife realized what was happening and tried to console him.  “That’s OK, Honey,” did not help. “It’s not your fault,” only made it worse.  Frank had not told anyone else about his situation.   To a man who is used to satisfying and being satisfied, there was not much to say. We talked about ways to make and express love without sexual contact, and ways to make sure that our women were satisfied.  When we had pretty much finished, he said that it had helped to talk, but, unlike the other stories, for me there was little humor here.  Maybe talking had helped, but man to man, no one had prepared the words for me to help the brother here.

There is one more thing they never tell you.  Actually, in truth though, they sometimes do.  As part of all the reading material and online resources available as preparation for prostate treatment, one might come across this wonderful bit of information.  Young men who achieve orgasm multiple times a week in their teens and early twenties have a much-reduced chance of developing prostate cancer later in life. 

Yes, they did finally tell me this.

About three decades too late.

I ain’t as good as I once was…..