“It is finished.”

Well, it’s official: I’m going to die alone.

This does not surprise me. I’ve known since I was 14 that I was going to die alone. The only surprise, now that I’m north of 50, is that it has taken this long.

More later.

How I am

I was down in September — really, really down — so my psychiatrist doubled my Lamictal dosage, upped my Wellbrutin dosage and added Paxil to the mix. Paxil and Wellbrutin were what I was on when I was mistakenly diagnosed as depressed, so I’m not sure what his thinking is. But it did help, after a couple of weeks, so I didn’t really think about it.

Now, for the past two days, I’ve just wanted to cry but can’t. I don’t know what that’s about.

The shot heard ’round the house

Sorry for the long hiatus. I’m now going longer between MD visits. I got a second opinion that pretty much confirmed my first. The differences are minor. MD No. 2 wasn’t quite sure some of my adolescent and early-adult episodes were full-blown mania, although he did take note of the fact that I ended my mid-20s episode fairly deeply in debt. He reviewed my meds and said he wouldn’t take issue with the cocktail. And, finally, he said that it was unlikely I’d slap my son in the head again.

Oh, yeah, about that.

I won’t lie: I’ve always had a temper. Frequently a pretty bad one. Even someone as emotionally unintelligent as I can figure out that that temper derives from unmet needs and wants. More lately, I’ve been wondering if a lot of the frustration with my kids doesn’t stem from Mrs. Prufrock’s being so physically and emotionally unavailable. There’s always something at work that she needs to stay late for, and none of them sound anywhere near implausible. (Beyond the tasks, she has had to mend a considerable number of fences on a personal level because her ability as an agent of change and improvement has made a lot of people feel threatened.) Add to that the fact that she has been making me take the kids in to school, often on very short notice, because she has trouble waking up, although I’ve been starting to wake her up close to an hour and a half before she has to leave to take the kids.

So: lots of drivers of resentment. And on Monday night, when my son wouldn’t do something I asked him to do and then mouthed off about it, I slapped him.

It didn’t really hurt him, although I did catch a bit of his ear. But that doesn’t really matter, now, does it? I slapped my kid in the head. I felt awful immediately, of course, and followed him upstairs to apologize to him. But what kind of monster slaps his kid in the head? When Mrs. Prufrock found out, she was, of course, furious. She barely spoke to me for two days, and then it was to point out that I was a lot harsher in my speech to him than to my daughter.

I brought this up today with second-opinion shrink. He seems to feel confident it’ll never happen again. I’m going to test that hypothesis tomorrow with  my talk therapist. I desperately hope it doesn’t happen again. And I wish I were more sure that it won’t.

Swimming upstream

In the “Captain Underpants” series, author Dav Pilkey (yes, that’s really how he spells it) always concludes his first chapter with, “But before I can tell you that story, I have to tell you this story … ” Lately, I seem to be stuck in the same boat.

Let’s say, as I did the other night, that I want to throw something away in the kitchen. Well, I go to do that and the trash can is overflowing. So now I want to take out the garbage. But it’s overflowed so much that before I can even lift the bag out of the can, I must open a new bag and put some of the overflowing trash into it.

When I’ve done that, then I can take the bag out of the garbage can. But I can’t take the bag out to the big gargage can outside because it’s been rolled out and around the corner for the city trucks to empty. So I have to put on shoes (and, in the mornings, a jacket) to go out and roll the big cans back around.

Then I can take out the bag full of garbage.

Then I can put the new bag of garbage in the kitchen can.

Then, and only then, can I throw away the thing I wanted to throw away in the first place.

I seem to be running into a lot of these things lately, work and home. I guess the solution, if there is one, is to try to think upstream in the first place, which is easier in some situations than others. It’s hard to explain why, but I seem to be having more trouble doing this now than I did in the past. I blame the meds, of course.

Speaking of meds …

I finally got a second opinion on my diagnosis. Type 2 bipolar, like the man said. The 2nd-opinion guy suggested a slight change in my Depakote dosage, which is cool because I’ve been hella groggy amost every morning of late. And now that I’m having to drive more for work than I did, that’s a good change from a safety standpoint.

After ditching the first counselor, I went to another one this week. Long story short, I think this is a guy I can work with. So that’s something.

And I got the promotion I wanted. It’s going to be demanding, but there were no surprises in my performance plan.

Finally, the range of my 1-to-10 numbers on my behavioral chart has narrowed, and it has narrowed up, not down — typically 4s, 5s or 6s. That’s good, I think.

Alice & the looking glass

I recently got in touch with one of my former girlfriends, not for any romantic reason but because she’s almost the only person I have ever been close to who had had receive treatment or counseling for any kind of mental or brain disorder. Her problems appeared to be more psychological than physical, although apparently she has been using Wellbutrin and it appears to have been working for her.

We’ll call her Alice because … well, let’s just say that when we were dating she took me through the looking glass a time or two.

At the time we talked, I had just changed from Lithium to Depakote as my bedtime snack. The Lithium had made me snappish and had given me tremors. More generally, I was noticing some of the problems I’ve already blogged about. I brought up what my doctor had said about not regaining the same levels of, well, ability I’d achieved in the past. He’d suggested I might not. She flat slammed the door on it.

Moreover, she introduced me to a concept that I hadn’t been introduced to before in terms of my own disease: rehab. Not in the drug-rehab sense, but in the injury-rehab sense.

She talked about learning how to compensate for certain types of damage. Having problems typing? Slow the hell down. Having problems stumbling into synonyms or even flat-out wrong words in your speech? Slow down AND don’t try to do anything else while you’re speaking. Forgetting stuff? Make writing it down Job 1. And so on.

She was upbeat and encouraging, but for all that, she didn’t sugarcoat the ways and means in which I’m going to have to change or adapt. She also didn’t sugarcoat the fact that all the adapting in the world might not be enough to make me an all-star once again.

Still, that level of effort won’t be optional. It might be necessary just to keep the bottom from falling out. As I’ve already pointed out, the kinds of mistakes I’ve been making in my typing may have real-world consequences for which I could be held accountable. And an amputee who gets fired for not closing enough deals is, at the end of the day, just one more guy who gets fired for not closing deals … and rightfully so.

And I owe my family no less, as well. It isn’t an issue of job performance there, of course; it’s an issue of my obligations to them as husband and father, obligations I take very seriously. They depend on me; they need reasons to keep doing so. I need to give them some.

Angry with Myself*

I go to see the shrinks
And one tells me that he thinks
That I’m schizoid, baby, and I wonder if I’m just
Angry with myself.

He gives me drugs to take
And he warns me they might make
Me rude and snappish at my kids and then I’ll be
Angry with myself, oh, oh,

Angry with myself, oh, oh,
Angry with myself
The Lithium just gave me tremors, um,
I’m just  angry with myself.

I know I’m not supposed to blame
Myself; I know it’s not a shame
And yet my past suggests
I flunked humanity tests, so now I’m
Angry with myself.

I take Lamictal to stay down
I take Zyprexa not to frown
There’s something else I take
So’s not to stay wake and still I’m
Angry with myself, oh, oh,

Angry with myself, oh, oh,
Angry with myself
Want to commit date rape wearing a Zorro cape
So I’m angry with myself, oh, oh, oh … (fade)

*Deepest apologies to Gen X/Billy Idol, from whose hit “Dancing With Myself” the melody of this song is taken.

The audience

I have been very concerned, perhaps unduly so, with how knowing that I have manic-depressive illness will affect people’s perception of who I am and what I do. There is a thin line between what is considered zany and what is thought to be — a ghastly but damning word — “inappropriate,” and only a sliverish gap exists between being thought intense, or a bit volatile, and being dismissively labeled “unstable” (p. 202).

From my mid-teens on, although I’m hardly the world’s most self-aware person, I grew and remained aware that even some of my closest hard-partying friends regarded me as, well, a little nuts. In high school, it was “extreme,” in college it was “hard core” and during my first couple of jobs it was “intense,” but they all meant the same thing: This Prufrock guy is, well, at least a little bit crazy.

At a party thrown by a co-worker not long after I left college, a co-worker admitted, under the spell of many drinks, that she had considered not inviting me to the party because she thought I was, well, “a little intense.” She could barely stand up at the time, so I didn’t follow up with questions. That’s kind of a shame. I’d like to know how she would have answered such queries as, “Did you think I might pose a physical threat to you or your guests?” or “Did you think that the knowledge that I was coming might have dissuaded your closer friends from coming?” I wouldn’t have asked just to be mean or snarky; I was then, and am now, sincerely curious.

I’m still negotiating this particular minefield (I just typed “mindfield,” a Freudian slip about which I’ll write more later). The first person I told was Mrs. Prufrock, but after her, I started with the people who had to know. That experience made me a bit gunshy about telling anyone else, as you can see.

Since then, I’ve told my sibs and few long-term friends, people who were around and in my life when this stuff first started to manifest itself. As you might expect, they all expressed sympathy and, even more importantly, they all linked the disorder, without my help, to incidents from our shared pasts. One has some mental disorders herself; I recently had a lengthy phone discussion with her, about which you will be reading in a later post.

But beyond that circle of trust I have not gone. There’s no need to at work, where I have enough problems as it is. Outside of work there are not only risks but also strong disincentives.

I have been involved in a certain type of public issue. My position has been about the worst type to offer in these situations: honorable and strongly argued, but complicated. People don’t intuitively get the points I’m trying to make sometimes, which makes it easer for opponents to sway members of the public with appeals to emotion, false comparisons and ad hominem argument. Moreover, my tone often gets heated. This happens because I honestly do believe these folks are deliberately making false arguments. (Why is another issue; I assume, but cannot prove, that they know they can’t make their case on the merits as well as I know it.)

And when my tone gets heated, my three principal opponents are quick to accuse me of being crazy, of having issues, and so forth.

Of course, they’re right. I am crazy, I do have issues — just none relevant to this issue and the debate surrounding it. I hold the position I hold because it is correct and honorable; I make the arguments I make because I believe they are accurate and logical. I’m willing to use appeals to emotion to counter same, but I will not stoop to ad hominem argument.

And I’ve got to be the public face on my side of this issue because no one else around here is doing the job that I’m doing. (Some are as capable but just don’t have the time or energy.)

If my condition were to become public knowledge, I am confident that our opponents would use it against me. On the basis only of what I have said so far, they already have accused me publicly of having psychological “issues.” Giving them confirmation, even if the issues relate to bipolar disorder rather than what they have in mind — narcissism, or schizophrenia or what-have-you — probably would do significant damage to our side.

Mental-health advocates like to talk about removing the stigma from mental illness. And as we recently were reminded, we have come a long way from the days when Tom Eagleton could get kicked off a presidential ticket because he had once undergone a few electroshock treatments. But that stigma still remains.

I’d like to come right out and say there’s nothing wrong with my disorder, not least because I believe that’s so. But the hard truth is that I cannot do so at work, and if I do it outside of work, I risk severely damaging a movement that a lot of people have put a lot of time into, a movement whose outcome otherwise might be months or years away. I can waste my time if I want, and perhaps someday I will. But right now I cannot, and will not, waste theirs. Perhaps that’s just an excuse, but now it strikes me as a damned good one.

* * *

Got a copy today of William Styron’s Darkness Visible. I’m not sure when I’ll get to it because I have a ton of work-related reading to do first. But it comes well-recommended. Perhaps I’ll give it the same treatment I’ve given the Apostle Jamison’s book.

What we talk about when we talk about bipolar disorder, cont.

There is no easy way to tell other people you have manic-depressive illness; if there is, I haven’t found it. So despite the fact that most people that I have told have been very understanding — some remarkably so — I remain haunted by the occasions when the response was unkind, condescending or lacking in even a semblance of empathy. The thought of discussing my illness in a public forum has been, until quite recently, almost inconceivable. Much of this reluctance has been for professional reasons, but some has resulted from the cruelty, intentional or otherwise, that I have now and again experienced from colleagues or friends that I have chosen to confide in (p. 199).

My resolve not to tell the people closest to me (besides Mrs. Prufrock, of course) lasted perhaps a day or two. Partly, I had to tell someone. Besides that, I accrete friends very slowly, so most of my closest friends know me fairly well (I would have said “very well” before the diagnosis) and witnessed or heard about some of the events I’m now re-examining in light of the diagnosis.

That said, I had serious reservations about telling the part of the company food chain I deal with regularly. In no particular order I worried about:

• Whether they’d think I was making it up as an excuse for my recent poor performance.
• Whether they’d use it as an excuse to fire me — not directly, but by giving me less and less desireable tasks, territories and whatnot until one day I just said “screw it” and quit.
• Whether they’d use it as an excuse to fire me by micromanaging and micro-observing what I did, documenting each minor misstep to accumulate a mountain of woodchips sufficient to burn up my job.
• Whether they’d just fire me flat-out and roll the dice on what happened next.

I thought about it a while and finally decided I owned them the honest and what happened after that at least would happen on that basis.

So, I told, in this order, our EVP, our VP, our Dept. Mgr., and the sales manager to whom I reported. And the — well, for lack of a better word, quality of each one’s response fell in that same order.

The EVP was absolutely wonderful. He acknowledged right up front that he didn’t know much about manic-depression but would take the time to look it up. He seemed to sit up and pay more attention when I explained the typical length of misdiagnosis and the fact that antidepressants often aggravate bipolar symptoms. In general, he asked me to keep him posted. I presumed he didn’t need to know the ins and outs of every change in med or dosage, but I told him I’d keep him informed of any major changes in my condition.

The VP was out on vacation that week, so I got with the department manager. He professed even less knowledge. More from his body language than anything he said, I got the distinct impression that this was the first time anyone working for him ever had brought him anything so … personal, almost like a cat coming through the pet door with a live snake in its mouth. If you’re not a snake person, your first instinct is to back away as fast the hell as you can, then figure out if it’s venomous. And whether or not it is, at that point your likeliest course of action is to get the snake, if not the pair of them, back outside as quickly as possible.

Still, he handled it very professionally. also pledging to learn more about the disease.

Finally, my sales manager, and almost everything he said could be summed up in three words. What. An. Asshole.

He said he had he’d had “a relative” with “some mental problems,” so he was familiar with my situation. Familiar! People whose full-time 8-to-5 work in postdoctoral studies on manic-depression don’t say they’re “familiar” with it, but that didn’t stop this sales manager from doing so. He didn’t say he’d study up on the disorder. He didn’t even ask me to keep him informed. I walked out of the meeting thinking, “If it’d been anyone but me, someone almost toxically loyal to the company, you’d have just bought the company an ADA lawsuit — one you amost certainly would lose.”

Fiduciary responsiblity much?

I’ve gone ahead and discussed this with some of my oldest and closest friends. Most profess to know nothing about bipolar disorder. I’m still waiting to hear from one with whom I’d discussed going on Paxil back when that happened. I’ve received some puzzlement, but mostly, in about this order, reassurance and sympathy. I’m not going to run out and become the poster boy for NAMI, in part because I don’t know how this might affect my chances with any future employer/insurer with whom I might have to deal. But I feel I’ve discussed this with enough people, and the right people, for now. To the extent that I’m discussing it with you, well, I doubt it inasmuch as my visitor count has been zero consistently, you don’t know who I am and in this medium I could be anyone and/or making it all up anyway.

Still.

Baby, meet bathwater?, or, Sophie’s Al’s choice

Do we risk making the world a blander, more homogenized place if we get rid of the genes for manic-depressive illness — an admittedly impossibly complicated scientific problem? What are the risks to the risk takers, those restless individuals who join with others in society to propel the arts, business, politics and science? Are manic-depressives, like spotted owls and clouded leopards, in danger of becoming an “endangered species” (p. 194)?

I know this is an autobiography. As you can gather, I think it’s incredibly educational. Still: Ick. Self-absorbed much?

And yet the platform past which her Solipsism Express raced wasn’t empty. There was a question standing there, awaiting an answer: What do we manic-depressives give up along with the medications we take to keep our episodes shorter, shallower and less frequent?

Perhaps I’m misremembering what Jamison said. I need to go back and look, and if I am misrembering, I’ll revisit this post. But I think she said what we give up is only that which makes our lives more dangerous.

It’s early in my rehab, so to speak, but I’m not entirely convinced this is true.

* * *

I’d been on antidepressants almost a year before my GP and I finally settled on what we thought was the right cocktail: 40mg of Paxil daily, 150mg of Wellbutrin in the morning and another 150mg at bedtime. It seemed to work. The side effects were noticeable and frequently annoying, but not horrible. They included constipation, near-total lack of interest in sex, and … well, not an inability to ejaculate, but it became much more difficult. Effects that might or night not have been attributable to either of the drugs included feeling warm all the time, which I’d sort of done all my life only substantially worse now.

The drugs also gave me something I hadn’t ever had much of: a filter between my racing brain and my mouth. Well, kind of a combination filter and 7-second delay. I still thought stuff, but some of it I now wouldn’t say at all and some of it I might say, but in a rephrased, more diplomatic fashion. I didn’t go over the edge into political correctness — politics aside, as a writer I’ve always preferred the precise and specific to the vague and general. But unless you like getting yelled or even cussed at from time to time, I was probably nicer to be around during the six years I spent on antidepressants than at any other time in my life since childhood.

That was great for other people. I don’t deny that. But it frequently felt to me like a long, uncomfortable pause — pauses so long you typically only see them in movie comedies — between the question I was asked or the joke I was told, and my response. This made my interactions with co-workers much less fraught. It had other benefits, too, such as improving my own joking demeanor. It never has been easy for me to keep a straight face. I can almost never avoid laughing at my own jokes, frequently before I finish telling them. On the antidepressants, the 7-second delay helped my straight face function a little. It also pretty much destroyed whatever need I felt to tell jokes, more on which in a bit.

The way I thought of this was that the meds were costing me my personality. That’s an exaggeration, perhaps even a histrionic one. But I was OK with thinking of the cost in that way because I thought of what I was getting in the same way: what I was getting in return was the rest of my life. My wife got her husband back (minus the ability to come quite as quickly as she sometimes wanted, but still). My kids got their dad back. Sure, I was a little less interesting. But I also was a lot less volatile. In a time of great stress for us with deaths in the family, overscheduling, kids’ illnesses and so forth, I think it literally made me capable of living the sort of life many people take for granted, or at least manage to get through without chemical assistance or abnormal long-term damage.

Only during the late summer and early fall of 2006 did I begin to realize that what had more or less worked for so many years wasn’t working anymore, at least in terms of my job and possibly — I wasn’t sure — in terms of my personal life. And that’s when I sought — and I’m so glad I did this on my own, because I’m not sure anyone would have suggested this to me until it was way too late — a referral to a psychiatrist.

* * *

What has transpired since then you know if you’ve read this blog. But I recently had a physical — the routine kind, the one you get every year (and thank God I’ve got a few years before the colonoscopy becomes a regular part of the routine; prostate exams are bad enough). After the routine parts, and the intrusive and gooey parts, were over, my GP and I discussed my psychiatrict treatment and counseling (and more on the counseling in a separate post). This was a particularly enlightening conversation because 1) my GP and I have known each other forever — indeed, since long before changes in our health insurance made it possible for me to move to his practice; and 2) his young son is a patient of my psychiatrist also.

I mentioned my work performance — how I’d recovered a good deal of my former abilities but feared I would never again perform at the levels I once had achieved. I likened it to one of the skill positions in football, in which not just speed but quickness — the ability to accelerate or to make 90-degree cuts instantaneously — can be lost forever if, say, the knee’s anterior cruciate ligament was torn. I was at least half hoping to hear instead that, no, with proper treatment and conditioning and enough work, I could once again be a professional skywalker, to so speak.

Instead, my GP said, in effect, no, you may never again be as good as you were, and you need to prepare yourself for that eventualilty. He wasn’t being harsh; his tone was extremely regretful. But he also wasn’t dancing around what he saw as the truth. (During this conversation, he also came probably as close as he thought he could come to admitting he’d misdiagnosed me without getting himself sued, not that I would sue him. It’s a very common misdiagnosis, as I think I pointed out earlier.)

So even if the company keeps me on, they’ll be getting substantially less for their money than they would otherwise, given the effects of treatment on my performance. On the other hand, without treatment I might perform very highly at times and not perform at all at others. As I aged, the latter would begin to outweigh the former in terms of both depth and frequency.

And then there’s, you know, the whole suicide thing.

* * *

Which brings us to Jamison’s question above: Are manic-depressives becoming an endangered species? And the implied follow-up: If so, what, if anything, should we do about it?

First, given its largely genetic nature (so far as we can tell) and the fact that we’re barely a few years into understanding how the human genome works on the micro level, I don’t think we have to worry about running out of manic-depressives anytime soon. If I understood my psychiatrist correctly, at least one of my kids stands close to a 50% chance of developing the disorder at some point.

That said, then hypothetically speaking, even if we were to develop some sort of gene therapy to cure (or, more likely, prevent) manic-depression, should we keep the manic-depressives we know we have anyway, or at least keep those who create and contribute at high levels?

One of my answers would be straight out of formal logic: 1) Not all manic-depressives are particularly creative/talented/visionary/productive/risk-taking. And 2) Not all creative/talented/visionary/productive/risk-taking people are manic-depressive. I don’t know that there’s any stastistically valid correlation. (Please correct me if I’m wrong.)

Another would be that the disease often doesn’t manifest itself until one is on the cusp of, if not well into, adulthood. A major change at that time, although almost certainly less damaging than a major change at, say, middle age, might still be incredibly difficult. At this point there’s no way to come up with an ethical double-blind study on the issue.

Another answer would be that, even though we know more about manic-depression now than ever, we still don’t know enough to keep from misdiagnosing it for an average of 10 years per patient.

My own inclination comes down on the same side as Jamison’s, but with the observation that if you want to harness at least some of the good things manic-depressives bring to the table without necessarily leaving them to die in a puddle of their own genetic stew, there’s more than one way to skin that particular cat.

One that has proven helpful at my company in recent years, is to have everyone do a Myers-Briggs test. One of the few things we use it for besides helping teams achieve better team dynamics is to find out who the ENTJs, XNTJs and INTJs are. Apparently, these are the visionaries, and in dark times you need to keep a few around not only for their substantive contributions but also (if they’re, um, mentally healthy) for their beneficial effect on group morale. This is almost certainly illegal, but then we’ve been able to shrink by attrition, so it has never become a factual issue to which law need be applied. (He said, crossing his fingers.)

So I guess as a socieity we ought to treat (in the medical as well as personal sense) treat manic-depressives as best you can and work toward engendering the best of what they bring to the table in other folks. For example, we typically think of “creativity,” however defined, as an innate gift. But there are certain things you can do to make it more of a craft for people who don’t think of themselves as creative. By “craft,” I mean something that you can practice and practice and eventually get good enough at to, say, entertain yourself, your friends and, just maybe, your employer, even if creativity will never be a huge part of your professional life. And creativity is just one area in which people, groups, organizations and society can take this approach.

So, don’t shoot us, we’re only the piano player. Or the CEO. Or the master carpenter. Or the rock star. Or the psychiatrist. Or the artist. Or the software developer. Give us the best treatment you can, and let us give back to you what we can in terms of contributions to society.

And for God’s sake, keep in mind we’re not the only ones who contribute. In fact, perhaps this whole post was just an exercise in self-absorption after all.

Sins of the fathers

From the book of Jamison:

… [the doctor] broke in to ask me if I knew that manic-depressive illness was a genetic disease. Stifling for the moment the urge to remind him that I had spent my entire professional life studying manic-depressive illness and that, in any event, I wasn’t entirely stupid, I said, “Yes, of course.” At that point, in an icy and imperious voice that I can hear to this day, he stated — as though it were God’s truth, which he no doubt felt that it was — “You shouldn’t have children. You have manic-depressive illness.” I felt sick, unbelievably and utterly sick, and deeply humiliated. Determined to resist being provoked into what would, without question, be interpreted as irrational behavior, I asked him if his concerns about my having children stemmed from the fact that, because of my illness, he thought I would be an inadequate mother or simply that he thought it was best to avoid bringing another manic-depressive into the world. Ignoring or missing my sarcasm, he replied, “Both.” I asked him to leave the room, put on the rest of my clothes, knocked on his office door, told him to go to hell, and left. I walked across the street to my car, sat down, shaking, and sobbed until I was exhausted (p. 191).

My father’s side of the family has a large set of long histories and traditions. They include almost universal male military service, at least until the post-Vietnam era. They also have included alcoholism and suicides. And because of those two things, I believe bipolar sickness might be a third. My shrink says that as a result, the odds that one of my children will develop bipolar disorder are somewhere north of 50%.

This disease sucks. It doesn’t suck like diabetes or cancer or heart disease, but it sucks nonetheless. It renders every interpersonal reaction you’ve ever had questionable in terms of means and motive. It calls into question your perception of “normal,” thus calling into question even the most beneficial instincts and inclinations you’ve spent a lifetime shaping. And then there’s the part where sooner or later you get into fights with everyone you’re close to.

Any sane parent wants all that for his children about as much as he wants a living room full of pony doo-doo on Christmas morning when they’ve been asking for, and expecting, a pony.

So what do you do? At what age should your children be told of the risk to them, that they might perhaps be more self-aware and act accordingly when symptoms begin showing? Or do you even tell them? I happen to think that kids are capable of handling a great deal when it’s presented to them in low-key, honest fashion. But I don’t think they need to be told everything as soon as possible. It’s like the old joke where the child asks mommy and daddy “Where did I come from?” and they stammer and stutter while they try to figure out how much to tell the kid about sex, at which point the kid adds, “because Lucy says she came from Ohio.”

If I had to guess, and I guess I do have to guess, I’d guess that unless symptoms showed up earlier, I’d just engage in what the prostate-cancer specialists call watchful waiting: Do nothing; see if symptoms appear. If they’re going to at all, they generally do by the late teens. If they haven’t showed up by then, I’d probably go ahead and tell the child around age 18 what to look out for and how dangerous it can be.

And love ‘em as hard as you can. If my experience is any indication, they’ll need it.