The Patient From Hell

CAVEAT: This did not unfold at the Mayo Clinic, or some gleaming temple of medical excellence where treatments are tailored and minds remain open. No, this took place at the Grand River Regional Cancer Centre in Kitchener, Ontario—a place where the oncology script is carved in stone and questioning it is heresy. The oncologist’s name was Anupam Batra. In another time, say the Middle Ages, he would have been known as Batra the Arrogant—the kind of man who, had he been handed a leech and a chalice of bile, would have declared the patient cured before they were even diagnosed.A Treatise on Medical Dogma, Testosterone, and the Inconvenience of Thinking

"What are you doing here? You're wasting my time."
— Medical Oncologist, on meeting a patient with inconvenient questions.

That was how it started. Not with a handshake. Not with a review of labs or imaging or any nod to the Hippocratic niceties. No. It began with a dismissal. The sort of tone you reserve for telemarketers, Jehovah’s Witnesses, or people who ask for ketchup in a French restaurant. Apparently, my crime was showing up to a medical oncology consult while daring to bring… curiosity. Questions. A hypothesis.

You see, I am that patient. The one who read the studies. The one who asked why the tumor, which grew quite nicely in a body that was already low on testosterone, would be further subdued by taking away the last drops of the very hormone it didn’t seem to need in the first place.

Let me rephrase that for the algorithmic minds behind cancer care protocols:
If the plant is growing in sand, is more sand the solution?

Welcome to the templated hellscape of prostate cancer treatment. You, dear reader, might have assumed that a cancer diagnosis would be followed by a nuanced discussion, a personalized plan, and perhaps the faintest glimmer of scientific curiosity. You’d be wrong. What you get is the Dogma Flowchart™. Do not pass Go. Do not collect options.

PSA high? Biopsy bad? Glands cribriform?
Initiate Protocol Alpha: Androgen Deprivation Therapy (ADT), External Beam Radiation, Brachytherapy boost. Three-part harmony. No solos allowed.

And so I asked the question that turned me into The Patient from Hell:

If a tumor develops in a naturally low-testosterone environment, isn’t it already living off the grid? Doesn’t that suggest it’s learned to survive — or thrive — without testosterone?

If you then remove the little testosterone that’s left, aren’t you, in effect, telling that tumor, “Congratulations, you’re now the fittest survivor. Here's your evolutionary incentive to get creative — metabolically, genetically, violently.”

To put it another way: when you cut down the last trees in a forest, the fungus doesn't die. It takes over.

But no. In the Holy Scriptures of Oncology, ADT is sacred. Questioning it is heresy. And so I found myself standing before the High Priest of Medical Certainty, who, rather than engage with the nuance of my case, declared me a waste of his time. A theological inconvenience in his evidence-based cathedral.

Now, let’s be clear. I’m not anti-science. I’m anti-template. I’m anti-treatment-by-pedigree-where-the-tumor-is-a-footnote. Because when your prostate decides to go rogue in a testosterone desert, that’s not a common case. That’s a molecular insurgency. A biochemical coup. And that deserves more than a Ctrl+C, Ctrl+V plan recycled from a 72-year-old with a beer belly and a midlife PSA bump.

I raised the possibility that ADT, in my case, might be fueling resistance. That what was sold to me as chemical castration for therapeutic good might in fact be encouraging the cancer to adapt, mutate, and metastasize out of spite.

I asked about AR-V7 expression, about genomic profiling, about whether a different systemic therapy might make more sense — not instead of ADT, but in consideration of the specific tumor biology. I might as well have been speaking in Klingon.

You see, templated medicine has no space for original thought. It rewards compliance, not questions. The oncological gods are busy — too busy, apparently, for patients who think their bodies might be more than a sum of statistics.

Let me tell you what they do have time for:

15-minute consults.

Pressed white coats.

Protocols laminated in plastic.

A religious belief in T suppression as cure-all.

They do not have time for men like me.
Men who ask what happens when you beat a hormone to death — and the cancer doesn't blink.
Men who suggest that maybe, just maybe, cancer is smarter than a flowchart.

So here I am.
The Patient from Hell.
The man who questioned the gospel of gonad suppression.
The man who thought maybe a cribriform, perineural, test-resistant tumor growing in a low-T body meant something.

And maybe, in time, they’ll write about patients like me in the medical journals — the ones they laughed at, ignored, or dismissed until the science caught up. Or until the tumors did something interesting enough to warrant retrospective attention.

Until then, I remain a heretic with hormone suppression.
And a sneaking suspicion that the real tumor is medical orthodoxy.