Doug - Extrapolated Worlds

Prostate Cancer – Part 1

Back in 2012 my employer was eager to get ahead of healthcare costs, so they launched an annual biometrics program where employees got screened for all sorts of things. The theory was that early detection would reduce the need for expensive treatment later. Oh, and of course, lead to better health outcomes for the employees, though it’s unclear to me whether that was a key driver of their decision making process.

In my case, there were two red flags, which are interesting case studies of what went well and what did not. Good news first: I had moderately high blood pressure. Not the kind of eyeball-popping blood pressure that puts you in the ER, but the kind that takes years off your life in the long run. Something like 150/110.

I am very interested in living a long time (with certain caveats, like being healthy and able to engage with the world more or less on my own terms). So taking years off my life was definitely not okay. After a few pharmaceutical experiments, I settled on a cheap medication that knocks off 20-30 points without noticeably affecting my quality of life. Note that experiments were necessary; the first couple drugs had side effects that made me question whether those nominal extra years of life were worth it. (If you find yourself in a similar situation, I advocate not sticking with the first shitty hand your doctor deals you.) So, good news, right? Problem found, problem solved.

Now the second red flag: a high Prostate Specific Antigen (aka PSA) score. A high PSA score indicates a man might have prostate cancer, or as I fondly think of it, root rot. There followed many very expensive, painful, and in one unfortunate case, life-threatening diagnostics. That last was a doozy. Everything was pointing to, “It is very likely you have cancer Mr. Franklin, but the only way we’ll know for sure is by taking a biopsy.” So the way they take a biopsy of a guy’s prostate is by sticking something kind of like a mini nail gun up the ol’ poop chute and punching a needle through the wall of your rectum, through various other layers, and on into your prostate. Twelve times.

I’m a standard-issue cis guy, so I didn’t have a lot of a priori experience about how sensitive prostates are, but lo all these years later I’ve had many things inserted into me and can tell you, as my gay brothers already know, that it is quite sensitive. Getting core-sampled with a nail gun through your poop chute twelve times produces an altered state I hope to avoid in the future. It also has the side effect of ramming whatever shit soup is still coating your gut deep into your tender bits. (This after drinking 80 ounces of yummy Moviprep strands you on the toilet overnight waiting for your big date with a nail gun.) The docs anticipate this problem and give you a huge oral antibiotic right before getting busy with their nail gun. I’m told it works for 99% of the folks involved. If you happen to be part of the unlucky 1% like me, you get sepsis, go down the proverbial drain, and get to be on a first-name basis with the staff of your local ER.

But really this is all a long aside, because after all that fun, it turned out that my specific kind of prostate cancer was likely to grow very slowly, and could probably be safely ignored for years to come. Take note: they can actually do genetic tests on cancer these days, but you have to ask for it specifically, in advance. Even though my particular flavor of root rot was just barely on the evil side of benign, the docs were very keen on taking my prostate out as soon as fucking possible to eliminate any risk. Or to pay for their fancy robotic surgery suite, because capitalism.

There followed a period of intense research on my part, because it seemed unreasonable, if my risk of dying of prostate cancer anytime soon was quite low, to have a procedure that would likely have life-long consequences ranging from incontinence, to not being able to have an erection without some kind of pharmaceutical or mechanical assistance, to not being able to have one at all. My read at the time was that 1/3 of men who get their prostates removed need diapers, and 2/3 were not going to have a normal sex life after treatment. That’s like putting two to four rounds in in my trusty Smith & Wesson .357 revolver and playing Russian Roulette with my junk.

Now… I know, sex isn’t everything. And sure, I’ll give it up before I give up life itself. But if I don’t have to? If giving it up is OPTIONAL? I have friends who were in the same boat and now swear by Cialis. It was driving them crazy, sitting on a ticking time bomb whose fuse was lit, but the length of which was only sort of statistically knowable. I get it. But the saying goes that most men die WITH prostate cancer, instead OF prostate cancer. Root rot comes for all men in the fullness of time. And sex is one of my very favorite things in life.

So I said no thanks, I’ll just wait this out. Which drove the docs nuts. They could cure me! “You, with the intact prostate! Get on the table right fucking now!” But no. It must be frustrating to know you can fix some guy’s problem for good, and have him refuse. As it turned out, I was on the forefront of a wave of refuseniks, so much so that these days a guy with my numbers wouldn’t have even had a biopsy. They’d probably wait until the PSA was much higher, or there was some kind of detectable growth or readily noticeable problem like you can’t pee. (Detectable with a finger – which is delightfully and misleadingly called a digital exam.)

But the problem remained that I had cancer. I knew it. It was in there. So I couldn’t just completely ignore it.

Stand by for part 2, wherein I have medical adventures in Germany…

The Transformative Ethic

“The Transformative Ethic” was the first short story I sold, and I am forever indebted to Charles Ryan for taking me on, and to David Cherry for his amazing artwork – both the cover and the interior! Aboriginal Science Fiction was a class act.

I finished “The Transformative Ethic” way back in 1990, while I was working – and living, four weeks out of six – at Cominco Red Dog Mine. Red Dog is the world’s largest zinc producer, and it’s located above the Arctic Circle. That far north, the sun sets for a month in mid-winter. The mine site is a self-contained village, with pre-fab living quarters and office buildings built on stilts to keep from melting the permafrost and diesel generators running twenty-four hours a day. It’s a bit like living on the moon, or an asteroid perhaps. Think Outland without the gun fights and sex-appeal of Sean Connery.

An amusing factoid about the office buildings is that they were constructed in the Philippines, and as a result had two undesirable features: a small population of large tropical insects, and a complete lack of air-conditioning. Because if you live in the Philippines, you’d think it’s always cold above the Arctic Circle, right? Makes sense. But in high summer the sun never sets, and it actually gets quite warm. And there are many, many, many mosquitoes who find the CO2 wafting out of open doors and windows just so deliciously appealing. As one of two on-site IT guys, I had the relative luxury of being able to retreat to the server room, just about the only cool indoors place to work in the summer.

Red Dog is the polar opposite (sorry, couldn’t resist) of the research bases down in Antarctica, dedicated to ripping one of the building blocks of civilization-as-we-know-it out of the Earth instead of improving our understanding of it. I cannot even imagine what its carbon footprint must be, not that we were thinking much about that in 1990. An uncomfortable tension of living in Alaska, one of the most beautiful places on the planet, is that it’s all paid for by the ugly business of resource extraction. “If you can’t grow it, you have to mine it,” the saying goes. Or pump it.

But one thing I learned about open-pit mines from direct experience – and subsequent monitoring of various catastrophic events around the world – is that they are intrinsically dirty operations that are inimical to the natural environmental. We tried hard to be good, really. I’d say Red Dog is (or at least was – no clue about current management) an ethical operator that tried to do the right thing. But here’s the deal: when you rip the “overburden” off the top of an ore deposit with ginormous machines, you expose everything underneath to the elements. There used to be a big old hill covered with tundra. Now there’s a big old pit instead, and that pit absorbs snow and rain, and that water has to go somewhere. It used to mostly just roll off into the nearest stream. Now… it seeps through a bunch of toxic metals into the nearest stream. And kills it. And kills the next, bigger creek downstream. And so on.

And then there there is the tailings pond, where all the sludge from the extraction process goes. As far as I know, Red Dog’s tailings pond dam has held up, but many others have not. And when they go, it’s a real disaster both for the environment and for any communities that are in the way, or rely on that environment for “services” like water. Or food. This is especially a problem for mines that become insolvent, which means the operator can’t pay for maintenance, much less remediation.

So my main takeaway from all this is that yeah, mining is 100% critical to civilization-as-we-know-it, and it is also a dirty business that is, in the long run, extraordinarily destructive of the natural environment. Which – make no mistake! – we depend upon to survive. That’s why people in Alaska are so adamantly opposed to Pebble Mine, which would wipe out an entire fishery if (or more likely when) it has a problem. Not to mention that all the profits from Pebble would go out of country to fat cats in Canada. I mean… it’s really a lose-lose-lose proposition for the folks who live here.

But I digress. Here’s my optimistic sci-fi author perspective: yeah, in the short term we need to mine it, and pump it. And that sucks. So let’s account for the actual full life-cycle cost (instead of unloading that onto future generations), and use that cost to drive toxic operations off-planet (I’m looking at you Psyche!) and build the infrastructure to meet our needs with non-toxic alternatives.

/rant