Button Up Your Overcoat

Friday night.

Marty tells me he's bleeding again, worse than before. "I'm afraid to wear khakis. The blood might stain them," he complains. But I don't want him to go to the Hilton in jeans - we're picking up an old friend who's in town for the National Broadcasting Convention. She and her new boyfriend are staying at our house for the weekend; I have activities planned for all of us.

I'm tired of our life being interrupted by this problem anyway, tired of dealing with doctors, tired of telling them there has to be a solution, that their diagnosis can't be right. I'm especially fed up with all those urologists acting as if I'm a pain in the ass for wanting my husband to stop bleeding from his penis every time he urinates. They seem to feel that I'm a special burden, interfering all the time because I myself am a doctor.

But I don't want to fight with them. That embarrasses him and gets him care from angry physicians. He wants me to be his wife, not his doctor. Besides, thinking back on the times I complained about doctors being difficult patients, about how they were unreasonable in their expectations or wrong in their self-diagnoses, I've vowed to try and forget I'm a doctor when he's the patient. I've forced myself to think: They're right; we'll have to live with all that bleeding coming from his prostate gland. Nobody knows why it's happening and there's no cure. At least there's no sign of cancer.

We're finally at the point where we can rationalize living with this, trying to have as normal a life as possible. After all, it's not as if prostate problems are rare over forty. Many of our friends have had biopsies to check for prostate cancer, though none of them have admitted to suffering from BPH (benignprostatichypertrophy), which is the diagnosis Marty's been given. That's a far more common condition - but one considered an old man's problem. Discussing BPH forces guys to imagine embarrassing examinations: doctors' probing fingers in their rectums, pressing on swelling glands that wrap around the urethra like a donut around its hole, obstructing the flow of urine from the bladder. They don't want to think about the treatment, either, often a trans-urethral prostatectomy (TURP), roto-rootering out the gland like a pipe clogged by a tangle of hair, a surgery that can lead to impotence.

Multiple doctors have felt my husband's prostate and declared it normal size. His PSA, the blood test for prostate abnormalities, gives no indication of cancer. I've even been able to nag him into bending over and taking it up the ass for me, as he said with a grimace, letting me feel it myself, to check that no gravelly area of cancer has been missed. I remember thinking, He's being silly, acting like this is a big deal, He ought to try a full gyn exam, and, I never thought I'd ever do a rectal on him, and, thankfully: They're right, it does feel normal.

One urologist explained the normal exam: "The hypertrophy must be like a donut with its hole closing up, all central." Obstruction from BPH increases the chance of infection, which can lead to bleeding - Marty's main symptom, and sometimes a big prostate bleeds with no identifiable cause.

That urologist refused when I asked for a prostate ultrasound to see if this donut-hole theory was true; he feared that a shadow of clot or infection would be taken for an area of cancer, forcing him into performing a dangerous biopsy on a non-cancerous but germ-ridden prostate. A TURP, he said, would also be too risky and probably not stop the bleeding.

After another painful episode of Marty standing over the toilet forhoursthroughoutthenight,unabletopassmorethanadribble at a time, we...