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One of the consolations of “getting on” (some might say) is that you get to spend more time talking to doctors – or rather having doctors talk to you with that casual condescension that probably takes a full year of training to acquire.

About fifteen years ago, concerned about the number of black and growing spots on various parts of my body, I ventured to the consulting room of a friendly and engaging dermatologist.  He ran his clever machine over my body, projected all kinds of enlarged and ugly images onto a screen and declared me entirely free of any concerning blemishes.  Those black spots?  “senile warts - nothing to worry about”.  After ten seconds of relief, I exclaim:.   “Wait, you call them what? Senile warts?”   “Yes” comes the breezy retort. “Nothing to worry about” which I am sure is the first time I have heard the words “senile” and “nothing to worry about” in the same sentence.

I recently returned to the same dermatologist at my wife’s urging.  Another, bigger, blacker and growing “wart”.   Same process, same outcome.  Only this time I am informed that it’s an “age appropriate” wart. He told me as he got a little older, he felt that this was a better sounding phrase.   I suppose I should be grateful that my warts have progressed from being senile to being age appropriate, but something about the term still niggled me.

Then I remember hearing the phrase before.  A year previously my GP had phoned me up one Saturday morning, my birthday actually.  Without even the obligatory “hellohowareyou” he tells me that my prostate blood test (PSA) was strongly suggestive of cancer (It was. The reading was over twelve and should be under three) and I needed to see him and a radiologist and urologist in quick succession.  And so I entered a procession of finger pointing (if you get my drift), and other procedures that led inexorably to twelve snips of my prostate, presided over by the urologist’s son in law (also a urologist).  It feels a little like insider trading.

 During this whirl of tests the radiologist, informs me that the enlargement of my prostate was “age appropriate”.   I think that was meant to be good news, but I could not help wondering why.  Perhaps it means my prostate waits until all its little prostate-off-spring have gone to bed before telling dirty stories?   

Somehow the phrase feels patronizing.  It has a kind of: “you’re lucky to be alive, stop complaining” air about it.  

Also, somewhere in this process I ask about false positives – are there explanations other than cancer to explain the high PSA reading?  Indeed, there are.  What are they, and why don’t we discount them before getting into the rather intrusive biopsy?  No.  First we look for cancer, then we look at alternative explanations.  No reasons given, it’s just that’s the way it is. OK, you’re the doctor. So it’s off to the urologists son-in-law, who performs the biopsy with as much dignity as is possible while you are having little clumps of cells harvested by a dinky little probe deeply embedded up your backside.

A few days later its back in the father-in-law’s consulting room.  While you sit there, he opens an envelope with the results, which he has not looked at.  It’s a kind of “money or the box” moment. (That is an age appropriate allusion: Springbok Radio 1960s – you had to be there.)

The doctor looks up with a slightly pained smile.  “The good news is that there is no sign of cancer.”  He says the words, he definitely smiles encouragingly in my direction, but you can see his interest waning as he says it.  He tells me he will send a report to my GP, but he never does.

I go and see my GP.  He puts me on a month of some antibiotic, and boom, my PSA reading is back down to below three.

I restrain myself from asking why we didn’t do the antibiotics first and the biopsy only if my PSA remained high.   But I swallow the words and accept that doctor knows best.  It seems like the age appropriate thing to do.

Cedric de Beer

September 2019