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December 3, 1999
Diagnosing Dad
Being a son first and a doctor second

photo: J. Kevin Shushtari

I got the call on my cell phone a few weeks ago in the middle of an executive meeting. "Mom & Dad," which I had programmed into the phone, lit up the display area. They never call in the middle of the day, so I excused myself and took the call.

"I just wanted you to know that my biopsy came back positive," said my 80-year-old father. "Biopsy of what?" I asked distractedly. "Didn't I tell you I was having my prostate biopsied?" he reminded me.

My father, who is a cardiologist, had been losing weight and feeling weak for the past year. I chalked it up to old age and gently suggested this to him as a possible "diagnosis." I'd been trying to persuade him to retire from the county hospital where he still spends five days a week reading patients' ECGs and conducting exercise-tolerance tests. He took my advice once, at age 75, but he became restless at home and quickly returned to work after only a short time.

Convinced his lethargy was something more serious than old age, he embarked on what we doctors call a "mega-work-up." He saw multiple specialists, underwent numerous diagnostic tests, including a colonoscopy, and finally discovered that he was anemic. Then about a month ago, his PSA level (a screening test for prostate cancer) came back extremely high. His urologist suggested a biopsy, and the diagnosis of prostate cancer was returned.

I knew my father would be strong. He has always been self-reliant, hardworking, and capable of facing adversity with courage. So the first thing I asked was "How's Mom?"

"She's okay, and I'm on Lupron," he responded. Lupron is a hormonal injection that helps contain cancerous cells in the prostate. My sister was there on the phone in the study, and she had numerous questions. I searched my memory, and as the other doctor in the family, I recited what I knew about prostate cancer:

"Prostate cancer is one of the most common cancers in American men and is diagnosed in approximately 200,000 men each year. Sixty to 70 percent of men over the age of 80 have the disease. Virtually all men over 90 have it. Most cases go undetected. It is most common in African American men over 60. When it affects men who are younger (in their 50s and 60s), it is typically more aggressive. Most prostate cancers are dormant; only 3 percent of men die from it. Nobody knows what causes prostate cancer. Surgery, radiation, chemotherapy, and hormonal manipulation are possible therapies. Bob Dole, Andy Grove, and Michael Milken are a few well-known prostate cancer survivors."

Since the majority of men over the age of 80 have prostate cancer, the news was not a real surprise. And since most prostate cancer is dormant, I was fairly certain this would not kill him. Statistically, he is more likely at his age to die from other ailments, like heart disease or stroke. We talked about all of this and his favorable odds of immediate survival, and went over future treatment options.

After we hung up, I wondered if I had offered him any comfort as a son, or as a doctor. I could feel his anxiety while we talked, and his struggle not to show it. I realized that my best role here was to just be his son. He knew the statistical details as well as I did, so I figured there was more going on with him than the news about his prostate.

Death, to him, has always been a frightening thought. He and I share that fear, although anxious dread is probably a more accurate phrase for what we feel about it. My father has marked time carefully over the years, wondering aloud about his aging peers or commenting on how youthful Frank Sinatra or Bing Crosby appear in the 1940s films we sometimes watch together. "And now they're dead," he laments at each passing of those from his era. Sometimes he revisits the old black-and-white photographs of himself as a dashingly handsome young man in 1942, his thick, black hair slicked back and his mustache perfectly trimmed. He points to his young friends in those photographs, and rather than tell me about their lives, he tells me when they died. "Enjoy your life now," he says with nostalgia. "It won't last forever."

Those comments always seemed cautionary rather than self-aware, as if he could put off getting old, just like he put off his retirement. But while we talked about his prostate cancer, I heard not caution, but actual fear. Not because his cancer is news, but rather because it wasn't a surprise at all. Statistically, his prostate cancer places him firmly in the position of an elderly man who is no longer in perfect health. Despite the fact that the news of prostate cancer and his lack of vitality and strength (from the anemia) are unrelated, they serve as reminders that he truly has ceased to be the man of his youth. I watch him now with wonder. Will I accept my old age with grace, as I know my father now struggles to do?

I realized that, for now, the best thing I can do is be there to listen, to spend time, to reminisce with him. Helping him create new memories with his grandchildren -- my wife and I have two little girls and a boy -- seemed like the natural thing to do under the circumstances.

After we got off the phone, I sent my parents plane tickets to visit us in Austin and I made reservations for them at a fancy hotel. This way, they could have a little vacation close to their grandchildren and I could check up on my father at the same time. Things worked out well. Despite his health problems, my father appeared energized by the trip and time with his grandchildren.

As my father and I channel-surfed between football games during his visit, I caught a glimpse of the 1954 film On the Waterfront. A young and handsome Marlon Brando was giving his famous, embittered speech decrying the lost opportunities of his youth. I quickly changed the channel before my father saw it. I wanted him to be here, now, enjoying this time with his family while he's still active. Watching him play with my own children, I wished for him the same wish I have for myself, that we can face our elderly years with hope, not blind fear. Even more, I wish for the time to see that dream come true.

 J. Kevin Shushtari, M.D., is's Chief Medical Officer and a co-founder of the company. He is also a board-certified internist with a medical degree from Dartmouth College. In Dr. Kevin's Column he will share his own experiences as a physician, a family member, and a patient.