Teach Us to Sit Still

TURP

Shortly before my fifty-first birthday, in December of 2005, my friend Carlo sketched a tangle of tubes and balloons on a corner of newspaper.

We were in a cafe in the southern suburbs of Milan.

'The prostate is like a small apple, right? Here. But it's getting bigger and more fibrous with age, it's pressing on this tube going through it, the urethra. It's choking it, see? So, what do we do? We sort of core the thing, from the inside. With a laser. Going up your penis. Make it wider.'

I could see that Carlo had made this sketch many times before. Chewing a doughnut, his voice had a believer's enthusiasm.

'Then we just burn away a bit of this valve, or sphincter, here, to make sure it opens properly. That's the base of the bladder.'

My bladder.

I asked: 'Why?'

'So it empties better, then you go less often.'

'What about sex?'

Now he needed a proper sheet of paper. He opened his briefcase. There was a complication. Expertly his surgeon's wrist traced out the same diagram a couple of times larger. 'When you pee, there are two sphincters that have to open, right? The one we've burned away a bit at the base of the bladder and another lower down. Well, when you climax, the sperm shoots in here, between the upper and lower sphincters. Got it? From the prostate into the urethra obviously. The lower sphincter opens and the upper one shuts tight. But, after the op, since we'll have opened the upper one permanently, you can get a situation where the sperm whooshes off up into your bladder instead of down through your penis. So you get a dry orgasm. Same feeling, but no stains on the sheets. An advantage really.' He smiled and took another bite of his doughnut.

I examined the smudgy tangle of tubes and cisterns. It was a question of dodgy plumbing. My sink was blocked. The toilet tank needed looking at.

'What about the pain?'

'Not that painful. You'll be in bed for a few days, then a couple of months before you can start sex again.'

'I meant the pains I'm getting now.'

'Ah.'

Carlo is a big man with an open, honest face.

'We can't actually guarantee they'll go.'

I had quite a repertoire of pains at this point: a general smouldering tension throughout the abdomen, a sharp jab in the perineum, an electric shock darting down the inside of the thighs, an ache in the small of the back, a shivery twinge in the penis itself. If the operation didn't solve these problems, why do it?

'Your bladder will empty better. You'll pee less at night. The pains will probably recede, it's just I can't guarantee they will.'

I said OK.

In the meantime, I should try a variety of pills.

'These problems tend to be hit and miss,' he said. He would put me in touch with a colleague who was up to date with the most recent drugs; for the moment I could start with alpha-blockers. 'They inhibit the reaction to adrenaline, which is connected to the impulse to pee.' He thought I might wake up only once or twice a night instead of five or six times. I tried the alpha-blockers. After a couple of weeks I was still getting up six times a night, and now I was constipated too. I stopped taking the pills and after another week things were back to normal. Normal bowel movements, normal pains. It seemed like progress.

Then shortly before Christmas, the 'up-to-date colleague' Carlo had sent me to, a small tawny-haired woman with a strong southern accent, handed me a sample of something absolutely new. 'Christmas present,' she smiled wrily. 'Different approach. Let's see what happens.'

For a while I didn't notice any change. Then I was happy to find I wasn't peeing so often. Then I was concerned that I wasn't peeing enough. Come New Year's Eve I was in serious trouble. I hadn't peed for ten hours. I had the impulse. I stood over the toilet. Nothing but pain. I stopped taking the pills. I called Carlo, but his cell phone didn't respond. I didn't have his home number. In the end, he was only one of a circle of friends at the university where I teach in Milan, while I actually live in Verona, two hours away.

Should I go to the hospital? The emergency room would be packed on New Year's Eve. There was also the consideration that I knew people in the local hospital. My next-door neighbor worked there. If I had gone to someone in Milan, it was precisely out of a childish desire for secrecy close to home. Who wants to admit to prostate problems?

I blew off our small party and went upstairs to bed well before midnight. I lay there rigid and angry. I was angry with the doctor who had given me these pills. I was furious with life for dealing me this card. My body seemed alien and malignant. We couldn't get comfortable together. Perhaps I am a parasite in my own flesh, I thought; and now the landlord has had enough.

In the past I'd always imagined I owned the place.

From downstairs, I could hear my wife and youngest daughter chatting and laughing with the neighbors and their kids, who were getting ready to let off fireworks in the garden. Their voices sounded distant. I was locked up in this stupid health problem. The space between us, between myself and my family, suddenly presented itself to me as part of a story, a scene in a film. It was the story of my decline into a pissy, grumpy old man.

When the New Year's fireworks began, I didn't get up and go out to the balcony to watch. All over town people were celebrating. I was in a dark cell, trying to figure how to get out, how to shake off this unhappy story that had started telling itself inside my head. Self-pity is a great teller of boring tales. I was at a turning point, with nowhere to turn.

Toward three a.m. I managed a trickle of pee. It took a while, but afterward I felt better. To celebrate I found what was left of the champagne and drank it. A good half bottle. Then I went down to the basement, turned on the computer, brought up Google and typed in 'TURP.'

Trans-Urethral Resection of the Prostate is the gold standard to which other surgeries for Benign Prostatic Hyperplasia are compared. This procedure is performed under general . . .

'Gold standard' seemed an odd term to use. But what if my prostatic hyper- whatever wasn't benign?

Following surgery, a catheter is used to remove blood or blood clots in the bladder.

I read through the same information on a dozen sites, then, without thinking, clicked on images. Immediately there was a photo of the grotesquely dilated opening of a penis suckering like a fish's mouth around a metal tube. I quickly moved the cursor and clicked on a more reassuring pencil sketch. A man in a doctor's coat and strangely old-fashioned hat was staring into something that looked like a cross between a telescope, a syringe, and a gun. About eight inches long, the instrument had little pistol triggers and flexible tubes entering and leaving from above and below. The man had his fingers on the triggers and an eye pressed to an eyepiece; at the other end of the tube was the tip of a penis, lodged in a conical opening. A rigid tube protruded from the instrument, traveled down through the penis, which was unnaturally straight as a result, and penetrated into a shaded area about the size of a squash ball just beyond the scrotum.

Beneath the image, a caption announced: In TURP, a wire loop is used to cut away pieces of the prostate.

I remember gazing at this sketch for some time. What struck me about it was the hubris of its clarity. This handsome, clean-shaven young doctor with his curious hat was Renaissance man exploring the heavens with his telescopes, Enlightenment man discovering the power of surgical instruments. He saw clearly right inside the body, my body, right into the quick of life, and he made neat, clinical cuts there with the most sophisticated equipment.

I switched to the Guardian's soccer page and read about a game settled by two goals in injury time. I need not decide about this operation just yet, I thought.