Kenneth L. Brigham
Hard Bargains: Life Lessons From Prostate CancerA Love Story (Harpeth House Publishing, $10.95 paperback, available from www.harpethhouse.com)
While known in medical circles for his groundbreaking articles detailing his discoveries in gene therapy for lung ailments, Dr. Kenneth Brigham began his first publication for the mass public with these three words: “I have cancer.”
With that simple, declarative sentence, at age 56 Brigham began chronicling a battle against prostate cancer that forever changed him physically and personally. At the time, he didn’t realize he was writing for anyone other than himself, but what originated as a personal journal at its May 10, 1996, inception has recently emerged as a 96-page book entitled Hard Bargains: Life Lessons From Prostate CancerA Love Story. It’s a frank, compelling, humorous, and horrifying look at the third deadliest cancer in men of all ages.
“I wrote it more to help me deal with this experience and to keep me from denying stuff that I had not really resolved,” says Brigham, now 61. “I was just trying to write exactly what I was feeling at the time I was writing it. It was only several years after all of that, that I went back and read it and thought it might help somebody else.”
Brigham stresses that his experiences should be of interest to anyone facing a potentially fatal illness. “It’s a real experience that a real person had with a life-threatening disease; I don’t think it’s specific to prostate cancer. It’s important too for people to know that they aren’t the first one and they can get over it.
“The fact that I am a reasonably well-adjusted person, and a doctor, gives a message too. Cancer plays no favorites. The human issues that are raised are the same no matter who you are. It doesn’t matter where you are in the socioeconomic spectrum when you are presented with a life-threatening crisis. The responses are common; we are all in it together.”
Now cancer-free for five years, this highly regarded doctordirector of the Center for Lung Research at Vanderbilt University Medical Center and the Ralph and Lulu Owen Professor of Pulmonary Diseasesspends his days researching lung illnesses at his Vanderbilt University School of Medicine office. His office decor suggests his split personality: Clad in a subdued gray suit and black sweater, he faces a staid black bookcase holding dry, cumbersome medical journals. Yet he sits in a mustard-yellow leather chair and is surrounded by colorful paintings by his close friend, Nashville artist Myles Maillie. Brigham is a serious respiratory researcher, but he’s also a genteel and sophisticated connoisseur of art, martinis, travel, and food. Like a veteran scientist, he speaks slowly and deliberately, almost in a monotone. It’s as if he’s not eager to offer a glimpse into his life outside the office.
But in his book, the East Nashville native shares every thought, memory, and fear that accompanied his journey to survival. Hard Bargains explores his treatment options, from doing nothing to undergoing external radiation to his ultimate choice: radical prostatectomy. “This is ‘the operation,’ ” he writes. “Bob Dole had it. Marion Barry had it.” He details the medical procedures in easy-to-understand language, and he also addresses who must be told about this disease and when.
Before undergoing surgery, Brigham was faced with a number of pressing matters that had to fall by the wayside. He was being hounded by a publisher for overdue chapters of a medical volume he was editing; he was planning a dinner for a visiting faculty member; he faced endless budget questions, faculty and fellowship appointments, and data to review. He had to cancel a scheduled talk in Aspen. In addition, he was in the midst of establishing geneRx+, a new biotech company. “And I have cancer,” he writes in response to all of this, “and the only reasonably sure cure will make me impotent.”
On May 30, 1996, the doctor became a hospital patient when a medical student informed him, “You are on the pathway”a reference to the medical world’s increased focus on efficiency.
“I really hated being a patient,” he says. “It’s terrible. But I had no inclination to go try to become the world’s expert on prostate cancer and be my own doctor. If so, I would have a fool for a patient. I wanted a good doctor who knew what he was doing, and I was totally willing and anxious to have him make decisions. I didn’t like being the patient, but I didn’t want to be the doctor.”
For the first time, Brigham discovered that his lifelong career was terrible preparation for being a patient. His modesty was compromised, and he was disturbed in the middle of the night by what he considered unnecessary blood-pressure and temperature checks. “I hate the surly nurse’s aid who takes my vital signs and am inclined to tell him so,” he writes. “I am so annoyed by the parade of patronizing interns and residents who take a woefully inadequate history and listen to my chest perfunctorily through the hospital gown. I hate the hospital gowns, which always have the ties missing so that your ass is never covered.”
Despite these annoyances, the surgery was nothing compared to the recovery. “It strips you of all of your pretenses,” he says. “You feel old and ugly and unattractive and unlovable. So all of those things you build up to seduce people into loving you are all taken away. It really does force you into focusing on the substance of your relationship.”
His first post-surgery bowel movement received cheers from his medical peers; he quickly developed a ritual for emptying his catheter bag. But perhaps surprisingly, incontinence, not impotence, was the most distressing side effect. “The fact that I am incompetent is the center of my life,” he writes. “Dare I get up to get the book on the dresser across the room and risk the nauseating and uncomfortable sensation of urine rushing down my urethra? Do I have an incontinence pad with enough capacity to be able to walk a block to a restaurant for lunch...?”
Brigham says he is frequently complimented on his bravery for discussing his illness. “I don’t fully understand that, because I don’t think it was an act of bravery to publish this,” he says. “People say, ‘How could you talk about impotence and incontinence to the world?’ But these are medical issues. They are things that occur. I didn’t feel like a lesser person in the eyes of anybody who reads the book.”
The doctor may write powerfully about overcoming incontinence and impotence, but this isn’t the centerpiece of the book. As he reveals, life goes on, no matter what. And thank goodness. He captures the joy of hearing a song by local blues singer Celinda Pink, the excitement of looking at a new building design from local architect Manuel Zeitlin, the rush of driving his Porsche. Perhaps the most lasting description is of the enviable, loving relationship he has with his wife Arlene, a Vanderbilt pediatrician.
“When you are faced with a life-threatening crisis, keep your sense of humor and deal with the cards you are dealt. But there can be some very positive things. I wouldn’t choose to have prostate cancer to be a better person,” he says with a laugh, “but having been dealt that card, I think that it can have some very positive effects on the way you look at life.
“I call [the book] a love story. It’s a love story because of Arlene, but it’s a love story about life too. It makes you appreciate things that it’s not easy to register. It makes you pay attention.”
Cancer made Brigham reexamine his own life, which led to his resignation from an administrative post at Vanderbilt Medical Center about two years ago. With these demands off his to-do list, he now focuses solely on research, which is what he has determined to be the best use of his gifts. He has learned to strive to be ordinary. “I spent most of my life wanting to be special, exceptional,” he says. “I came to realize that it’s not what you want, really. You don’t want to be special; you want to share your humanity with your fellow humans. That is what you really want, because if you are special, you are alone.”
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