Giving The Finger To My Prostate Exam

There is no shortage of humor regarding one particular part of a man's physical exam: the digital rectal exam of his prostate.

See, you probably just smiled -- in your mind, at least -- at the thought.

Some men may smile recalling a particular joke. I still remember a scene from the 1980-ish TV show Lou Grant where Lou (Ed Asner) was suffering through the DRE as part of his newspaper's company physical. Through gritted teeth, Lou asks the doctor for one favor: at this exact moment when he's examining a newsroom colleague, please tell him, "Lou Grant says hi."

Or, a man might smile over the fact that he just had his physical, so it's almost a year until he's got to do it again.

Perhaps a guy will smile out of fear -- a silent version of nervous laughter.

There's only one reason a woman would smile at the thought: she can't believe men are such whiny, wimpy bitches about one little indignity, compared to the litany of poking and prodding she and her sisters endure.

To me, because both my father and his father developed prostate cancer, I felt the exam was vital. I didn't enjoy slipping my underwear down and rolling onto my side, but once I hit 50, it had to be done.

"Okay, knees up to your chest," my longtime doctor would say while lubricating his gloved finger. "Just relax, this will only take a moment."

Sure, I'd think, relax. Lying here exposed, suffering anxiety-induced shrinkage like George Costanza after that cold pool. Feeling the first touch, then the insertion. I got the added benefit of my doctor's play-by-play. "Okay," he'd intone, "slowly now ... there it is. It's soft ... it's smooth ... it's symmetrical ... very good." Those words should have made me smile, but that's hard to do with a locked jaw.

His next move never made sense to me, though I was in no position to question: "Now for the turn," he'd say as I'd feel his finger rotate. But it did signal the end was near as he began to withdraw. "And... we're done," he'd announce to my immense relief.

The invasion part may have been over, but I'd still be lying there with my shorts around my ankles and my backside smeared with lube. So he'd hand me a box of Kleenex. "Here you go, wipe your bottom." (No, of course I didn't expect him to do it.)

I'd pull out handfuls of Kleenex, wiping and disposing as fast as I possibly could. Two, three, maybe four swipes later it was good enough, and I could yank my underwear back up.

"Finish getting dressed, then meet me in my office," he'd say. "Will do," I'd answer, heart rate, breathing, and manhood returning to normal.

That kind, caring, wonderful doctor (he actually made a house call to treat my ailing mother-in-law, and later shuffled half a day's appointments to attend her funeral) finally retired at age 80, meaning I had to start over with a new Primary Care Physician. In my late 50s, I wanted a younger doctor who could take me across the finish line.

I did some research, made an appointment, and a mere five months later had my first visit. And what a difference it was.

My new PCP, in his early 40s, didn't make notes in a chart, he entered data on a rolling computer terminal. He didn't write me a prescription to take to my pharmacy, he submitted it through his computer. It even came out that unlike my old doctor who lived in one of nicest parts of Beverly Hills (and deservedly so), my new physician lived not far from me.

And there was another difference. After finishing at the computer, he finally approached for the hands-on portion of the visit. He took my blood pressure; he looked in my eyes, ears, and throat; and he listened through his stethoscope to my chest and back. As he put it down, I girded myself for the "slide down your shorts" moment. Instead, he just said "Okay. We'll contact you about your test results, and I'd like to see you again in five weeks. Very nice to meet you."

He extended his hand to shake, which I did while trying to think of how to ask why the index finger I held hadn't known me better. But the handshake was too quick, and my brain was too slow, and he was gone.

While waiting for that subsequent appointment, I had a new thought: maybe the first appointment had been all about history, and the next would be the "real" exam.

But at that visit, the nurse didn't say anything about getting undressed. And then with the doctor, other than taking my blood pressure, all we did was talk. Finally he indicated we were done.

Better prepared than last time, I said, "Not that I look forward to this, but I do have that family history, and I'm used to having the digital prostate exam."

"That's old school," he said. "An excellent study says it's correct about 10 percent of the time. Less than flipping a coin. We'll keep an eye on your PSA, which is really low. And watch for other symptoms."

And with that, he was gone. I sat there, stunned. That was it? No more lubed finger invading, evaluating, twisting, retreating? No more wiping with an audience? No more embarrassing shrinkage? Wow! Without all that, this whole physical exam thing was a piece of cake!

I know there's a lot of controversy about many aspects of prostate cancer, from its detection through the choices of treatments. But for me, for now, I'm gonna go with my new, New School Physician.

I think this is the beginning of a beautiful Doctor-Patient relationship.

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