PSA: Don’t Judge

I have been in Lloyd Austin's shoes. Here's what I learned.

Defense Secretary Lloyd J. Austin III returned to the Pentagon on Monday for the first time in more than a month, the Defense Department said, after his surgery for prostate cancer and hospitalization for related medical complications.

Mr. Austin was widely criticized for failing to immediately disclose his illness and absence to the White House, a breach of protocol that baffled officials across the government, including at the Pentagon. (New York Times, January 30)

On Thursday, Secretary Austin held a press conference in which he said, “I did not handle this right…I was being treated for prostate cancer. The news shook me. I know that it shakes many others, especially in the black community. It was a gut punch. And frankly, my first instinct was to keep it private…”

(Warning: This piece contains graphic medical descriptions and is not for all readers)

The Rabbis of the Talmud have a famous saying: Do not judge another until you have been in their place. I have been in Defense Secretary Lloyd Austin’s place, and there are some things I have learned. They have taught me even more emphatically not to judge. 

I was diagnosed with aggressive prostate cancer in April, 2019, and have been treated for it ever since. I’ve undergone hormonal treatment, surgery, and radiation, and continue to be on two cancer drugs. Over the course of that time, I’ve also been hospitalized for an intestinal blockage, which appears to be the complication that sent Secretary Austin back to the hospital.

We’re just special

Secretary Austin and I both belong to populations more likely to be struck with aggressive  prostate cancer. He is African American; I am Jewish and have the BRCA genetic mutation. So if you’ve heard of “active surveillance,” “cyberknife,” or other precision methods for excising prostate cancer (stop by our offices twice and go run your marathon), that’s not for us. When TV personality Al Roker publicized his bout of prostate cancer a couple of years ago, and interviewed his surgeon on the air (fun fact: we had the same surgeon), he had the milder kind of cancer, which can be targeted and removed, while saving the surrounding tissue. When you hear, however, that someone had a prostatectomy, it means that the entire gland had to be removed, and sometimes lymph nodes to which the cancer has spread. (We won’t talk about spread to the bones.) Such cases also often require additional therapies, like radiation and additional hormonal medications. “Minor” and “elective” this is not.

To tell or not to tell?

Before my surgery, I had been on hormonal treatment for 6 months. The combination of powerful pills and injections waged war on my testosterone, which serves as the fuel for tumors. You never know how much you need your testosterone until it’s not there. A lack of testosterone reduces sexual desire and function. It can also wreak havoc with your confidence and optimism. It makes you feel less like a man. In fact it can give you biological traits associated with women, such as increased breast tissue. It certainly makes you rethink your role as a husband and as a counselor. How does a Rabbi advise others, when lacking basic self-assurance? I began to take an antidepressant and see a psychiatrist to compensate. I do not know if Secretary Austin has been on such hormones, nor do I know if they have affected him similarly. But you can begin to see, in light of such possible side effects, why a person would think twice and thrice before publicizing a prostate cancer diagnosis. In my Rabbinic experience, I’ve known people who insisted on keeping their condition totally secret. On the other side of the spectrum, I’ve known those who drew great strength from the support of others and were very open about their cancer. Most people fall somewhere in the middle.

Pain

At the end of prostate surgery, the surgeon inserts a catheter which drains urine (at first bloody urine) for the next week. It is held in place by an inflated balloon. The physical sensation ranges from awkward to painful. The psychological effect is, well, ewwwwwwww! It is typically removed, without anesthesia, a week later if the patient can urinate on his own. The removal felt, at least to me, literally and unexpectedly breathtaking. If you think that I am exaggerating, consider that both the #1 hit show Reacher and the #1 science fiction novel, Project Hail Mary by Andy Weir, have built on the pain of improper use or removal of a catheter to evince agony in their fictitious worlds.

Reports of the complications that followed Secretary Austin’s surgery sound as if they included an abdominal blockage, an inability for the body to pass waste materials through the intestines and out of the body. This is acutely (read: Shoot me now!) painful and often involves the insertion of a nasogastric tube, NG tube for short, through the nose and down to the stomach. This piece of equipment, routine to the physician, is highly uncomfortable to the patient, and discourages both swallowing and speech. Try running a Defense Department with one of these dissecting your insides. Hopefully the obstruction will resolve itself through the use of the NG tube related tests. Otherwise surgery might be necessary.

Judgment

Following my prostate cancer diagnosis, I inhabited another world. I felt like Harry Potter, who, while attempting to travel to the Wizarding thoroughfare of Diagon Alley, mispronounced the name and ended up in its evil analogue: Knockturn Alley, center of sinister dark magic. Unlike Harry, who had the benevolent Hogwarts half-giant gamekeeper, Rubeus Hagrid, to rescue him, no one was coming to rescue me.

I wrote a letter to my congregation, breaking the news. I thought the letter was upbeat and moderately detailed. It was actually gloomy and overly detailed, but it took someone else to point that out to me. The second draft was much better. I had learned not to rely solely on my own judgment. Does this mean that Secretary Austin’s judgment is now impaired and he should step down? I don’t know because the most important lesson I have learned on my journey is: No two cases are identical and Your Mileage Will Vary. In other words, while I have stressed similarities between us, there are many differences, as well.

In light of all this, should we excuse Secretary Austin’s secrecy and overlook his delay in informing the President and the cabinet of his whereabouts and condition? Not at all. But we should understand those behaviors. In the absence of clear procedural directives, the very human feelings of fear and shame can easily combine with the vulnerability, shock, and pain of the moment to compromise judgment. There need to be clear protocols formulated, both for the secretary and for his staff to ensure that everyone knows their responsibilities at sensitive times of emergency. (At the press conference he said, “We’ve already put in place some new procedures to make sure that any lapses in notification don’t happen.”) The American people need the assurance that their highest officials will be reachable, or at least that their duties will be competently covered every moment of every day, while at the same time, those officials deserve to know that at times of crisis, their humanity will be respected and their privacy guaranteed.

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