Playing the odds

From our overstocked archives

Sam Smith, 2002 - The 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 in his later years, who was 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. He initiated a campaign that resulted in the first hiring of black bus drivers by DC Transit. Hobson and CORE forced the hiring of the first black auto salesmen and dairy employees and started a campaign to combat job discrimination by the public utilities that led to a permanent court injunction to prevent Hobson from encouraging people to paste stickers over the holes in punch-card utility bills. He directed campaigns against private apartment buildings that discriminated against blacks and led a demonstration by 4,500 people to the District Building that encouraged the District to end housing segregation. He conducted a lie-in at the Washington Hospital Center that produced a jail term for himself and helped to end segregation in the hospitals. His arrest in a sit-in at the Benjamin Franklin School in 1964 helped lead to the desegregation of private business schools. 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 track system, teacher segregation, and differential distribution of books and supplies. It also led, indirectly, to the resignation of the school superintendent and first elections of a city school board.

Hobson was also a statistician with a well honed inclination towards the rational. In the early 1970s he came down with multiple myeloma. It was generally assumed he was a goner. A testimonial evening brought 2,000 people out to what Hobson called his "wake," as he sat in a lounge chair and smoked 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 mother, a teacher up from Alabama, ended a powerful speech with the benediction, "Go, son, go," which brought the audience to its feet.

Then Julius went home, promptly 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, that 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 I then 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 the 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 chance.

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 despite 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 magic of an Alexander technique practitioner.

During that trouble 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 cases, though, I felt oddly in charge of my own 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 over the next decade about some axis of evil in my body.

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."