There is a fine old limerick that I once found amusing. I still do. Let me tell it to you:
There once was a man from ’Stanbul Who soliloquized thus to his tool: “First you robbed me of wealth, then you took all my health, And now you won’t pee, you old fool!”
I am the “man from ’Stanbul.” Yes, I cannot pee. Oh, I can squeeze out a few drops here and there. I can dribble; I can even trickle. Occasionally what passes for a stream arcs into the commode. But it’s no McDonald’s golden arch, let me tell you, not the yellow rainbow of satisfaction I once knew so well, the Victoria Falls of my not-so-distant youth.
Yes, folks, I am going to tell you, in intimate detail, about my body: a marvelous machine, but capricious and susceptible to malfunction. It grows in places where it shouldn’t grow. Rife with invention, too prolific for its own good, it sprouts baubles and beads of errant flesh like bulbs on a Christmas tree.
It is just a little after two in the morning. In exactly nine hours, at 11 A.M., I will enter the outpatient surgical unit of Montefiore Medical Center here in the Bronx and put a very personal part of me at the mercy of a beam of concentrated light so powerful it vaporizes flesh.
I’m talking about my prostate, an organ (or, more precisely, a gland) universally characterized by unimaginative physicians as “walnut sized,” though anyone in my shoes will tell you that its size can vary greatly, from walnut to apple to grapefruit, progressing always from small to large. For though men are known to shrink with age, their prostates never do. The gland’s purpose: to secrete that milky fluid known as semen, which mixes with sperm from the testicles to form the gooey syrup of life itself.
The word prostate comes from the Greek word meaning “to put before.” What my prostate has been put before I don’t know, but I can say what it’s wrapped around, namely my bladder. If there’s an argument to end all arguments over intelligent design, this is it: No intelligent God would have been so dumb as to locate this most growth-oriented organ around man’s pee hose. Yet that is just what my dunce of a Creator has done. He has pitched this expanding semen factory where I piss, has strangled my urethra with it, has grabbed it like a straw between two fingers and pinched.
The resulting condition is called “benign prostatic hyperplasia,” or “BPH.” Here the word benign means “not a threat to life or long-term health, especially by being noncancerous,” as opposed to “having a kind and gentle disposition.” Believe me, there is nothing kind about a swollen prostate. Nor is there anything gentle about being roused ten times a night and forced to drag your groggy bones to the toilet, only to stand there, inert as a statue over a fountain, yet unable to do what fountains do so well. You turn the spigot on the sink, spread your legs like Ty Cobb, close your eyes and contemplate the fabulous waterworks at Tivoli Gardens, the Grand Cascade at Peterhof, the spouting dolphins and spewing gargoyles at the Villa Lante. You stand on a rug to make sure the bottoms of your feet aren’t cold, having heard somewhere that cold feet inhibit the bladder. You harbor misty memories of once having peed like King Kong, like Gulliver, like Zeus. Never mind campfires: your hose could have extinguished the great fires of Chicago and San Francisco. You recall how, as a boy of six or seven, you signed your name in snowbanks, the cursive melting and steaming with the heat of your body’s golden ink, a fleeting testimonial to the Palmer handwriting method. In service-station restrooms across America, along highways, behind great oak trees, you let your kidney juice fly. In high school, while waiting in the wings during a performance of Camelot, seconds prior to the scene where you, Lancelot, sang “If Ever I Would Leave You” to Guinevere, you poured yourself into a red fire bucket littered with gum wads and cigarette butts. You think of your dead father, the first man you ever saw take a leak outdoors, of how you and he would stand side by side at the driveway’s edge at twilight pulling out father and son dicks: his tawny and uncircumcised; yours minus its protective sheath (thanks, Dr. Spock) and pale and small as the bud of a white English rose. Together you’d aim into the Queen Anne’s lace and milkweed. Watching his glittering parabola, you’d say to yourself, When I can pee that far, then I’ll be a man!
These fond memories do you no good as you stand there blocked as a pipe full of concrete. Should mercy shine upon you, you might acquit yourself of a thimbleful of piss, just enough to wet the rim of the commode and dribble down your leg. You give it another five minutes, your thoughts by now gone abstract: the geometry of bathroom tiles, the fractal algorithms of the water stains on the shower curtain, the brown tongue of rust under the sink faucet. Urinous puns assail you: To pee or not to pee. Let it pee. Piss on earth. Pee of good cheer. None of this is helpful. You feel, furthermore, that you are being watched, that this is a scene in a supposedly funny movie — one by Neil Simon — of which you are the hapless star. For your own sake, you crack a little smile in the medicine-chest mirror. But your smile isn’t convincing, and you forfeit your Oscar.
In despair you take a warm shower, to rinse the urine from your leg and also because the warm water coursing down your shoulders and back helps relax the muscles of your bladder neck, loosening its contractions. Though this often works, it has always been your last resort, in part because you really don’t feel like getting wet in the middle of the night, and also because you know how displeased your wife would be if she knew that you peed in the shower, which is her bathtub. Yet into the shower you go, and piss you do — not much, but then, it’s hard to say with the water running off you. What spouts from the tip of your dick may be from inside you, or it may be courtesy of the New York City public drinking water supply system. (These days the difference may not be that great.) Still, just the semblance of fluid draining from your penis is grounds for gratitude.
This comic opera has been performed nightly, sometimes ten times a night — or about once every thirty minutes — with the first overture waking me always at 2 A.M. There is no point trying to sleep between performances. It only makes it that much harder to drag myself to the commode when the time comes. But drag myself I do, as I have this morning (it is now 2:48), since anything beats lying there listening to my bladder cry, Empty me! Empty me!
My first urologist, whom I’ll call Dr. L., wasn’t a bad doctor. In fact I suspect him of being a decent man, though one with little enthusiasm for his work. And who can blame him? What are a urologist’s dreams made of? Does the faint tang of urine ever leave their nostrils? What draws them to their work? Was the high point of their youth a day at Splash Mountain or Water Mania?
Dr. L.’s office was on Manhattan’s Upper East Side. The waiting room was painted (appropriately) yellow and crowded with men and women, all of whom wore the troubled expression of the incontinent. If you listened carefully, you could hear bladders filling. I was given a form to fill out, asking about my “voiding history.” On a scale of one to ten I was to score stress, urge, overflow, waking, dribbling, volume, and frequency. I filled in the answers quickly, with the same sense of resignation and doom as when I took the SAT.
Eventually I got to see the doctor, a bland-looking man with a white smock whose taste in neckties was questionable. I put out my hand for him to shake, but he was already leading me to his office. I may as well confess here my prejudice against doctors who don’t shake your hand. I don’t care if they’ve been shoving their fingers up people’s bums all day. The right of refusal should be mine.
We chatted, with him taking notes. I admired his Montblanc fountain pen while continuing to disapprove of his neckwear. Having distilled my symptoms into a few sentences on a sheet of yellow lined paper, the doctor took me into another, far less sumptuous room. He had me drop my pants and bend over with my back to him, my head thrust forward, and my elbows upon a padded gurney. Now came the handshake, urologist style.
“Well,” said Dr. L., feeling around in there, “your prostate is a bit bulky.”
Bulky? What did that mean?
The doctor asked how old I was, and I told him: forty-eight. (I’ve since turned forty-nine.) “Hmm,” he said. “Young for BPH.”
What was he implying? That I’d abused my prostate through too much sex? Or perhaps the opposite: I hadn’t given it enough sex, depriving it of its intended function, like a hunting dog kept on a chain in the backyard.
Dr. L. snapped off his rubber gloves. “I’d like you to do a flow test for me,” he said, and introduced me to his assistant, a dark-skinned woman no older than twenty-five, attractive, but with a set-upon quality and a pugnacious, fed-up look on her face. She led me to another room. “I need you to pee in there,” she said, pointing to a rickety folding lawn chair, circa 1967. The plastic webbing had been removed and replaced by a large white plastic funnel, such as my wife uses to transfer the extra-virgin olive oil she buys by the three-liter drum into smaller, easier-to-handle bottles. From that funnel, my own extra-virgin essence was supposed to drain into a device attached by wires to what looked like a seismograph — but was actually a flow meter — ready to chart my effusions on a tonguelike slip of graph paper.
They might as well have asked me to fill the Grand Canyon to brimming. I teetered over the funnel but couldn’t work up a single drop. It didn’t help that the doctor’s assistant stood just outside the door, so close I could hear her popping her bubble gum, asking me continuously if I was “done yet.” I pictured her tapping her professional white nursing sneakers on the cold linoleum. If I can piss just one drop, I said to myself, just one miserable little drop to get me started, then, by God, I’ll unleash a flood, I’ll piss a fucking tsunami! I tried all my usual tricks: running the water, humming softly to myself, imagining Japanese lily gardens and rain forests heavy with dripping vegetation. Below me the seismograph gurgled and whirred, like a hungry stomach wanting to be fed.
Fifteen minutes later I finally stepped out of the little room and said to the waiting assistant, “No go.” She gave me a look that I imagined she’d given to many a failed lover in bed. “Guess I must be nervous,” I added, which only fueled her contempt.
But there was no time to brood: Dr. L. awaited me in yet another room, one that might well have been labeled “Torture Chamber” for its menacing racks of implements. The test is called a “cystoscopy,” leading one to think it has something to do with cysts and scoping them out, when in fact it involves passing a fiber-optic viewing device through the penis and into the bladder. Now, I have nothing against having things shoved up my penis per se. But when the thing is the size of the Palomar Mountain telescope, I find cause to object. Surely an object so large was never meant to intrude upon such a small (and, may I say, delicate) space? Yet there was the doctor’s frowning assistant slathering it with K-Y Jelly as one might slather a ballpark frank with mustard.
Dressed in an examining gown, I sat practically naked on the equivalent of a rubber diving board with a U-shaped opening carved out of its forward end, the better to let my private parts dangle free and unencumbered. Until then I had maintained a modicum of what might have passed for dignity. Now all bets were off. Taking my limp member into her hand with less interest than she would have shown a garden slug, the nurse explained, “This’ll make you numb.” No sooner had she offered this inadequate prediction than, using a hypodermic, she squirted something into my shaft. I felt a brief shiver of cold, then nothing, only the lingering impression that I had just been violated, along with a sympathetic confusion for my poor penis, which must have thought it odd indeed for someone to ejaculate into it.
But the real fun had yet to begin. Dr. L. snapped on his gloves again, and his assistant wheeled close a metal cart bearing what looked like a plumber’s snake. Dr. L. said, “Try to relax.” (Apparently I looked anxious.) “I’m going to explain everything I’m doing.” Dr. L. was a man of his word, detailing every inch of the assault as he advanced like General Sherman on Atlanta. “I’m introducing the probe into your penis,” he announced. Yet I felt only a vague imposition, a rigid coolness rising from deep in my depths: it must have been that numbing jelly. Dr. L. told me to cough. “Again,” he said. “Again.” With each cough the plumber’s snake advanced another inch. “We’re getting to the prostate now,” he announced with the cool Midwestern drawl of an airline pilot pointing out the Rocky Mountains down below. And how about that royal we? Was he referring to him and me, or him and his moon-rocket-sized apparatus?
“You may feel a little something right about now.”
Quite so, only the “little something” was a hurt the size of Alaska. Determined to convince Miss Mercy of my manliness, I contrived to suppress a scream, my cheeks awash in involuntary tears. The doctor’s assistant remained unmoved. What did it take to impress some people?
With the plumber’s snake withdrawn and the examination concluded, Dr. L. said, “Congratulations, you have a ball-median valve.”
Hooray, I thought, and waited for my cigar. Meanwhile the doctor explained that prostate glands have two outer (or lateral) lobes and one median lobe, so named because it sits between the other two. When this middle portion of the gland enlarges, it sometimes sends a knob of tissue up the urethra and into the bladder opening, blocking it. The round knob of tissue plugs the opening like a ball stuck in a hole, hence the analogous ball valve.
“You have a few choices,” Dr. L. said. “You can try and live with it. Or we can put you on drugs and see if that helps. Or we can do a minimally invasive procedure and get rid of the growth.”
Obviously I couldn’t live with it, or I wouldn’t have come to him. Being a good American, I opted for the pharmaceuticals. If a drug might help me, why would I undergo a procedure, however “minimally” invasive?
Dr. L. filled out two prescriptions: one for Proscar, to slow prostate enlargement, and another for Flomax, to relax the muscles in my bladder neck. “There is one potential side effect,” the doctor said as he scribbled away with his Montblanc. “You may experience retrograde ejaculation.”
Retrograde. I had heard this word applied to planets in astrology. I knew, for instance, that when Mercury is in retrograde, human communications are known to break down, and even cars, computers, and telephones sometimes malfunction. My breakdown would be of a much more personal nature. Namely, I would not be able to come anymore. Well, I would still come, technically speaking, but with no substantial result. With my bladder-neck muscles chemically subdued and unable to contract at the proper moment, my semen had a choice: make the long, arduous journey through a thin tube and out the tip of my penis, or take a shortcut into my open, airy, hospitable bladder. Now, what was my semen more likely to do?
My prescriptions tucked into my wallet, I stepped out of the doctor’s office and into the light of a sunny day. (Why is it that bad news so often comes on lovely days?) I was feeling sorry for myself, but I had nothing to complain about, really. Except for this one problem, I was — and am — in excellent health. I’d always taken good care of myself and even swam competitively in local meets. In my last race, I’d finished third out of 150 competitors, some of them dedicated athletes in their twenties with bodies out of a Bill Blass underwear ad. They’d sent me home with a trophy, a seductively curved chunk of beveled glass with the words SECOND PLACE MALE etched into it. (The unintentional mockery was not lost on my wife.) And I still look young. I have all my espresso-colored curls, yet to turn gray (though a spitefully pigmentless shaft occasionally springs up from an eyebrow). So far I’ve managed to hold on to my youth, to cling to it, as a shipwrecked sailor clings to flotsam in the open sea.
Before leaving Dr. L.’s office that day, I hadn’t felt forty, much less forty-eight. Now I felt closer to sixty. At the very least — and on the false assumption that men live to be a hundred on average — I had to consider myself middle-aged. In the history books the Middle Ages are often referred to as the Dark Ages; I began to see why. Buried deep within the brightness of this sunny day was a darkness I had only just started to detect, a sense of life as a roller coaster plunging toward imminent decay and death. My life was more than half over. And with this understanding came an even less welcome one: that the now-completed half had been the half with all the fun stuff — idealism, vigor, sexual stamina, an agile and flexible mind, a beautiful body free of unwanted growths and obstructions. Only I hadn’t known it; I hadn’t known just how young I was. My youth had been like a beautiful city you ignore because you happen to live there. In a few apt words, I’d pissed it away.
And now we come to that delicate portion of my story wherein I must tell you about my orgasms. Yes, I must. I said I once peed like an angel. Well, I used to come like the devil. I’ve seen enough porno films to know the difference between a squirt and a spurt, and I spurted. Back in those innocent days when hand jobs were about all a young lover could reasonably expect, a girlfriend of mine once remarked (on witnessing this spectacle for the first time), “Wow, it’s like a fountain!” And it was: my very own Old Faithful.
Now all that would be lost. Ah, youth. Mine had been spent — and spent and spent! — and the bill had come due. I thought of that chilling scene in Saul Bellow’s novel Mr. Sammler’s Planet, where, as the old professor delivers a lecture at Columbia, a student heckler shouts out from the back row, “Why do you listen to this effete old shit? What has he got to tell you? His balls are dry. He’s dead. He can’t come!”
There I was, Mr. Sammler, walking down Park Avenue in the sunshine of a bright spring afternoon, the tulips ablaze in the esplanades. I noticed something different about the women sharing the sidewalk with me, those good-looking Park Avenue women with their trim business suits and their regal, stiff bearings. I’d always been attracted to them, to the delicate air of authority and perfume they exuded. They reminded me of Madame Glover, my junior-high French teacher, who wore short skirts and sat on her desk with her pantyhosed legs crossed, rendering me, in the front-row center, the happiest twelve-year-old on earth. Now my eyes were drawn to the Park Avenue women only out of habit, the way one still flicks on a light switch when the power’s out. Though in fifteen years of marriage I’ve been as monogamous as a barnyard goose, still I’ve felt entitled to my fantasies. But for my fantasies to work, there has to be the possibility, however remote, of them really happening. With my sexual arsenal about to be converted to a kid’s cap gun, what was the point of even daydreaming? Why slip away down mental dark alleys with theoretical conquests if only to experience my own mortification there?
That evening I didn’t tell my wife anything. I didn’t want to upset her. Besides, I had a sneaking suspicion that she wouldn’t have been all that upset, which would have upset me. I wanted her to care about my growing older and, more specifically, about my endangered ejaculations. But the plain fact, ladies and gentlemen, is that the only people who really give a damn about men’s ejaculations are men. And though we are pleased to equate our climaxes with hurricanes, typhoons, geysers, and so on, they are more like what happens when you slam down a telephone receiver: on your end it sounds like a big deal, but on the other end there’s only a click. Most women would just as soon have their male lovers shoot blanks. For one thing it’s a lot less messy; for another it greatly decreases the risk of unwanted pregnancy. (Long ago my wife and I decided against having children.)
So I said nothing and took my first dose of the drugs, following which I performed a rudimentary test and found, to my relief, that nothing had changed.
Alas, the test was premature. The drugs took a week or so to kick in. Six days later, sure enough, like the planet Mercury, my ejaculations went retrograde. It wasn’t, I learned, just a matter of nothing coming out, but a distinct change in the quality of the experience, a loss of what some men describe as “pumping action.” One still achieves a “climax,” but it’s a climax in quotation marks, with an asterisk. It’s like a hearty meal eaten with a head cold, or the colors of a flower garden on a cloudy day. The first time it happened, I grew instantly, tearfully nostalgic for my old orgasms. I felt sad. I felt sorry for myself.
I stopped taking the drugs.
Over the next six months, faced with a Hobbesian choice between orgasms and urinating, I went on and off the drugs several times. Peeing — and the sleep that went with it — usually won out. Then the drugs stopped working. I’d grown immune to their effects. Or, as my next urologist, whom I’ll call Dr. K., put it, I had “failed” the drugs. (Not the drugs had failed me, but I had failed them.)
I’d started seeing Dr. K. hoping there might still be some solution short of a “procedure,” and because I still remembered the way Dr. L. hadn’t shaken my hand, and that hideous necktie of his, and the fact that he never looked me in the eye. A man who’ll shove his finger in your rectum but won’t look you in the eye can’t be trusted.
Dr. K.’s office was in the Village, in itself a reason to like him. He was a Spaniard, with a Spaniard’s graceful manner and taste in furniture: a gilded rococo desk and matching chairs. His charms notwithstanding, the best that Dr. K. had to offer me was a procedure called “photoselective vaporization of the prostate.” “PVP” uses a laser to “vaporize” unwanted tissue. This was the latest in a bubbling alphabet soup of “minimally invasive” procedures for treating BPH that included TUNA, TUMT, TURP, ILC, and WIT. Of them all, PVP was the latest and least ugly. An outpatient procedure, it took less than an hour and more often than not sent one home catheter-free, a tantalizing prospect.
So far Dr. K. had performed all of ten PVPs, less than a month’s worth. Considering some of the possible complications (including the dreaded retrograde ejaculations), I was reluctant to let him target my prostate with his phaser. Instead I brought my business to Dr. R., who was young and eager to rise to the top of his specialty, with a gleam in his eye and the hint of a smile on his lips. All of this I deduced from a photograph on his website. My encounter with the actual person only reinforced this opinion. Not only did Dr. R. shake my hand, he did so eagerly and asked me where I’d bought my shirt. (Now that’s what I call bedside manner.) In his examining room, when I instantly assumed the position, he threw up his hands and said, “What, no foreplay?” I knew then that I’d found the urologist for me.
Dr. R. did some tests, all of which I’d submitted to before, but he administered them with far more humanity. The results left no room for doubt: I needed a procedure.
It’s 7:37 A.M. The sun is up, blazing in the east. Out the window, the Henry Hudson Bridge, which connects the Bronx to the northern tip of Manhattan, gleams with the light of a new day. A torrent of traffic flows, streams, rushes over the blue steel rainbow toward the city.
Yesterday morning, while looking at myself in the bathroom mirror, I saw something strange. At first I couldn’t tell exactly what it was, but it had to do with my lips. I thought of John Singer Sargent’s famous definition of a portrait as a painting that has “something wrong with the mouth.” But as I kept staring, I saw something wrong with my eyes, too, and with my jaw, and my nose, and my chin, and my forehead.
Then it hit me: I looked older. It was no longer a young man’s face that greeted me in the bathroom each morning. This was a middle-aged man’s face — a youngish middle-aged man, true, but definitely middle-aged. My face had caught up with my prostate.
And yet there was something not altogether unpleasant about this. There was even a sense of relief. For years I’d been holding back age as the Dutch boy with his finger in the dyke held back the sea (a urological image if ever there was one). I had been working so grimly at staying young, at being the age I felt I should be that, paradoxically, I had worn myself to a frazzle. Call it the Dorian Gray effect, only in my case I had kept the outside young at the expense of the inside — which suddenly, while I wasn’t looking, had slipped into middle age.
In a few hours Dr. R. will vaporize my errant prostate tissue, and along with it (I hope) whatever remains of my desire to cling to youth. There’s something bracing about surgery, even the least invasive sort. Like slugging whisky or smoking a cigarette or digging a ditch, it puts one’s priorities in perspective. My priority now is to grow old — gracefully, I hope, but nevertheless to grow old; to trade in my boyish dreams and desires for the dreams of a healthy, happy, humble middle-aged man.
Am I looking forward to this procedure? No. But I don’t dread it, either. And I do look forward to getting it over with, and trust that it will go well.
It’s not just a part of my prostate that I’ll be shedding. It’s a part of my past: my boyish self-image, my unquenchable sexual vanity and desire, all those tired old fantasies, the flotsam and jetsam of youth. Good riddance. I am a boy no more. I am a man. The man from ’Stanbul.