Stoicism and Testicular Cancer (Part 2)

I thought that I would have made a follow up post to this much sooner than I did, and that I would be recounting the post diagnosis events in detail, so that I could look back on it at some point and re-read it all. But as I was writing those details out, it seemed more like I was just opening an old wound to see how much it hurt, and how much pain I could take. I wasn’t actually helping myself that way. I wasn’t reflecting, I was ruminating.

So I am going to try to take a different approach here and just summarize what happened:

  • Back in November of last year, I was diagnosed with Testicular cancer.
  • I made the decision to take care of it within a week of the diagnosis.
  • I had the testicle with the tumor in it surgically removed.
    • Nurses on the whole are pretty awesome.
    • Getting a catheter put in you is not super fun, but it is bearable.
    • My family and friends are pretty awesome.
  • I only had to take a week off from work to recover from surgery, and was back to feeling 100% within about a month and a half.
  • Turns out, I caught the cancer in the earliest stage possible, looks like it didn’t really have the chance to spread based on the biopsy.
  • I need to have periodic blood labs and CAT scans done for the next 2 years to make sure the cancer doesn’t come back, if it does I will need chemotherapy, but it is still very treatable, even in that situation.
  • I should be fine, but I still need to go to a sperm bank to have my fertility double checked.

Overall it was a difficult experience, but on the whole, I am proud of how I dealt with it. It is still somewhat difficult to think about and deal with at times, especially since there is still a degree of uncertainty left, but life is always full of uncertainty, that is just the way it is. My second blood lab to keep an eye on the cancer is tomorrow.

My studies in Stoic theory and practice continue as they always have, just with a little more perspective now. In the end, Marcus puts it best:

So henceforth, in the face of every difficulty that leads you to feel distress, remember to apply this principle: this is no misfortune, but to bear it with a noble spirit is good fortune. – Meditations, 4.49

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Stoicism and Testicular Cancer (Part 1)

This multi-part post is going to act as a catharsis for me more than anything, but I think there will still be some value in sharing it with others. Last November I was diagnosed with testicular cancer. In these next few posts I am going to attempt to document what I went through the past few months, along with how I used Stoicism to help and guide me through the ordeal.

This all started roughly in October, the week before Halloween. While I was washing myself in the shower I noticed that something felt strange. My right testicle felt harder than usual. It was fairly easy to tell something was off since I did indeed have two testicles to compare against. One testicle was squishy, the other was not so squishy anymore.

Now thankfully I had a pretty decent health class in high school where we talked about these kinds of things, so the idea of testicular cancer did flash into my mind for a moment. At that point though, I figured there was no reason to jump to conclusions right away. Perhaps I had somehow hurt myself while rolling around in my sleep or during some other activity. I was not in any real pain, so I decided that I would keep an eye on it for a week to see what happened and go from there.

After waiting for a week it had not gotten better. The hardness was still there, and now I was starting to get minor shooting pains in my testicles as well. At this point I had a bit of an internal struggle, a decision to make. Do I wait longer to see if this goes away on its own? Or do I go see a doctor? Going to see a doctor was not a very appealing option at the time. After moving the Brooklyn I had not found a new Primary Care Physician (PCP), and since I am relatively healthy, I had actually not been to the doctors once in over four years.

This meant that I would have to go through the process of finding a new doctor in NYC that accepted my insurance, he would have to check me out downstairs, and it would hopefully not be awful. I decided to ask the two people who I knew had a lot of experience with finding doctors, my parents. They were able to give me some good advice on where to look, and I was able to schedule an appointment for a physical.

Surprisingly enough, this was probably one of the most difficult and critical steps of the entire process. I could of very easily ignored what was going on, blown it off, and moved on. Health is a preferred indifferent after all right? It doesn’t really matter whether I get sick or not, I can still live a good life, at least, according to the Stoics. But I also remembered that while my health and my body are a preferred indifferent, the use of my body, and the choices I make about it are not an indifferent. How I use what I have is what matters, that is where virtue comes, from your choices. I figured the wise choice would be to get checked.

I am also fond of Immanuel Kant and some of his ideas. For those of you that are not familiar, Kant is all about Dentology (rules and duties). You have duties to others that you must morally fulfill, but, you also have duties to yourself as an individual. I felt that if I just ignored this issue, I would be neglecting a duty that I owed myself.

So I went and got my physical. The doctor examined me and agreed that something felt off. He immediately mentioned that testicular cancer was a possibility, and if that was the case, that I would probably need my testicle removed. He said that I needed to get a sonogram of my testicles to check and make sure. He also made sure to mention that even if it was testicular cancer, that the vast majority of people went on to live normal lives afterwards. He recommended a couple of places where I could get a sonogram, and said that it wasn’t urgent, but that I should get one sooner rather then later.

At this point, I was just glad that I had made the right decision to get checked out, that something was indeed off as I had suspected. I told myself again, just like before, at this point it was too soon to say anything for sure, that there was no reason to freak out  or think I had an issue yet.

I recalled a quote from Seneca

Yet what could be more senseless than suffering over what had not yet happened? Rather than awaiting future trials, you are summoning them to your side! Better you should delay them if you cannot dispel them altogether. – Seneca, Letter 74.33

Even though this was my primary mode of thought at the time, I knew it was important to not push testicular cancer off the table as an option entirely. If I rejected that as a possibility, if I said that there was no way it could happen to me, and then it did, I would be far worse off than if I accepted that fact that it was a real possibility.

Yield not to adversity, trust not to prosperity. Fix your eyes on fortune’s privilege, thinking that whatever can happen to you will indeed happen. What has been long expected is easier when it comes. – Seneca, Letter 78.28

You might feel like Seneca is contradicting himself in these two passages, but he isn’t really. In the first passage, he is saying that there is no point in suffering now over something that hasn’t happened yet, that it actually makes no sense because you just end up suffering twice. In the second passage he is suggesting that you do a premeditation of adversity. To realize that anything can happen to you, that nothing is truly off the table. And that when you accept this, then, if some trouble really does come your way, you will be better prepared for it.

Seneca combines these two ideas into one in a later letter:

Wisdom lies in combining the two: you should neither hope without doubting nor doubt without hoping. – Letter 104.12

This is some of the best advice out there in dealing with unknown events that may happen in the future. It helped me a great deal during these early stages.

So I scheduled my sonogram at a Radiology Clinic in Brooklyn for the next week. It was a bit of a trip to get there from my apartment. A 40 minute subway ride into a part of Brooklyn I had never visited before. Little did I realize that the clinic I had scheduled an appointment with was in one of the worst parts of Brooklyn. I realized as soon as I got out of the subway station that I stuck out like a sore thumb in that area.

My first reaction was “uh oh, maybe I shouldn’t be here”. But then I thought about it for a little and remembered that the Stoics always had a cosmopolitan outlook, that these were human beings just like me, and that at this moment, they didn’t deserve any of  the judgement that I was about to pass on them.

If he did wrong, the ill lies with him; but perhaps he did not. – Meditations 9.38

The above passage is saying that if someone does wrong, that choice lies with them, but also, it is possible that they did not do anything wrong at all. It is difficult to know the actions, intentions, and circumstances of other people, so we should not be so quick to judge others.

Another relevant passage that came to mind is as follows:

But I, who have observed the nature of the good, and seen that it is right; and of the bad, and seen that it is wrong; and of the wrongdoer himself, and seen that his nature is akin to my own – not because he is of the same blood and seed, but because he shares as I do in mind and this in a portion of the divine – I, then, can neither be harmed by these people, nor become angry with one who is akin to me, nor can I hate him, for we have come into being to work together, like feet, hands, eyelid, or the two rows of teeth in our upper and lower jaws. To work against one another is therefore contrary to nature; and to be angry with another person and turn away form him is surely to work against him. – Meditations 2.1

One technique that I have picked up from these ideas, which has been suggested and mentioned elsewhere, is that in awkward situations like this, that we should call other people our “brothers and sisters” (internally in our heads at least, not out loud). It makes it much more difficult to have any sort of negative or apprehensive thoughts towards other people when you think of them in this way. It is also true in a sense like Marcus says, we may not be related by blood, but we still have a shared humanity with one another. As social animals we were made to work together, so, lets work together.

I made it to the radiology clinic without any issues, and, still sticking out like a sore thumb, filled out the required paperwork, waited, and was eventually called in for my sonogram. This, I can tell you, was probably one of the most awkward parts of the ordeal. I got to lay down in a chair with my testicles exposed, while a guy with a bunch of goopy gel and a plastic wand got to rub my testicles for 30 minutes in-order to scan them. I was periodically told to clench like I was going to the bathroom, probably so that the technician could get a better scan of the testicles in different raised and lowered states, but for the most part, I was just lying there still the whole time.

I don’t know if there are any Stoic exercises that apply to this situation in particular, but I can say that doing simple mindfulness meditation, and counting my breath, was very helpful. It allowed the time pass by more quickly and also kept me relatively relaxed.

After the scan was finished, I was told that they would send the results to their radiologist to be checked, and that I could get my own copy of the results on a CD, which I did. Their radiologist would call my doctor with the final results, which would happen within a few days.

That was all done on a Saturday. I figured it would take a little while to get the results, probably not till Wednesday. I ended up getting a phone call from my doctor that Monday morning while I was at work. I was busy at the time and didn’t have the doctor added as a contact, so he had left a message on my cell phone. The message went something like this “Hi, we got your results back. It isn’t very good news…but it could be worse…I guess…call me back when you have the chance”.

At that point my heart-rate skyrocketed and I probably went into high octane adrenaline mode for about 30 seconds. I thought to myself, ok, this is officially happening, I probably have cancer. After calming down a bit I called the doctor back, he wasn’t available and I was told he would call me back when he had a chance. Great, more waiting. I tried to go back to work and keep myself occupied for the meantime, probably not getting too much work done in the process.

I got a phone call back from the doctor withing an hour or so. He confirmed what I had thought. Yes, I had a tumor, it was most likely testicular cancer, I very likely needed to have my testicle removed, and I needed to schedule an appointment with a specialist now. Ok, time to get busy.

What should a philosopher say then, in the face of each of the hardships of life? ‘It is for this that I’ve been training myself; it is for this that I was practicing.’ – Epictetus, Discourses 3.10.7