SCENARIO: A 28-year-old man presents to urology after his fiancee found a painless testicular mass during intimacy. Ultrasound confirms a 3.2 cm solid hypoechoic mass in the right testicle with increased vascularity. Tumor markers are elevated: AFP 380, beta-hCG 12, LDH 420. He and his fiancee are planning their wedding in four months and had been discussing starting a family. He asks if the surgery will make him 'less of a man.'
Before You Read
What to Look For
- •
The Question Beneath the Question: 'Will I still be a man?' The SOAP note categorizes this as 'psychosocial distress re: body image, masculinity' — clinically appropriate, entirely insufficient. The poem compresses it to its breaking point: 'he asks me will I still be / and stops.' The incompleteness is the meaning.
- •
From Bystander to Origin: The SOAP note records the fiancee as 'present, engaged, asking questions.' The prose gives her agency and resolve. The poem opens with her: 'She found it first, / her hand in the dark / finding what the light / would have to name.' Across three forms, she moves from modifier to the one who initiates the entire narrative.
- •
What Statistics Actually Do: The SOAP note lists '>98% 5-yr survival' as prognosis. The poem watches the patient receive it: 'I give him numbers / ninety-eight percent / and watch him build / a floor to stand on.' In the exam room, a statistic is not information — it is architecture a terrified person constructs a next moment out of.
Lens I
SOAP Note (EHR)
AI-generated for educational purposes. Not a clinical document.
SUBJECTIVE:
'My fiancee found it about three weeks ago.' Describes a painless firmness in the right testicle noticed during intimacy. No prior testicular complaints, no history of undescended testicle. Denies weight loss, back pain, shortness of breath. Since the ultrasound results: 'I can't stop Googling.' Fiancee present at bedside, engaged, asking questions. Tearful when asking about fertility — the couple was planning to start trying for children after their wedding in 4 months. 'Will I still be able to... be normal?' and, looking at his fiancee: 'Will she still want me?' She takes his hand. No family history of testicular cancer. No known allergies.
OBJECTIVE:
VS: T 36.7, HR 78, BP 128/82. Gen: well-developed, anxious young man, fiancee at bedside. GU: R testis firm, nontender, 4 cm palpable mass, does not transilluminate. L testis normal. No inguinal LAD. No gynecomastia. Abdomen soft, no masses. US R testis: 3.2 cm solid hypoechoic mass with internal vascularity, heterogeneous echotexture, concerning for malignancy. L testis normal. Tumor markers: AFP 380 (H), beta-hCG 12 (H), LDH 420 (H). CT C/A/P: no retroperitoneal LAD, no pulmonary mets. CBC, CMP wnl.
ASSESSMENT:
28-year-old man presenting with painless right testicular mass, elevated tumor markers (AFP 380, beta-hCG 12, LDH 420). 1. R testicular mass, highly suspicious for nonseminomatous germ cell tumor given elevated AFP - clinical stage I pending surgical pathology. 2. CT staging negative for metastatic disease - favorable. 3. Fertility preservation needed prior to orchiectomy. 4. Significant psychosocial distress re: body image, masculinity, sexual function, fertility.
PLAN:
1. Sperm banking - URGENT, must complete before surgery. Referred to fertility clinic for cryopreservation, appt tomorrow AM. Discussed that 1-2 specimens adequate for future ART. 2. R radical inguinal orchiectomy scheduled for next week pending sperm banking completion. Discussed surgical approach (inguinal, not scrotal), expected recovery 2-4 wks. 3. Discussed that with one testicle: testosterone levels typically normal, sexual function preserved, natural conception usually possible. Pt visibly relieved. 4. Post-orchiectomy plan depends on pathology and staging: likely surveillance protocol for stage I NSGCT (cure rate >95%), possible 1 cycle BEP if high-risk features. 5. Discussed prognosis: stage I NSGCT has >98% 5-yr survival. Pt and fiancee both tearful with relief. 6. Testicular prosthesis discussed - pt interested, will revisit after orchiectomy. 7. Counseling referral for adjustment support - both pt and fiancee. 8. Pre-op labs, EKG, anesthesia eval ordered.
Lens II
Narrative Medicine: Prose
A Testicular Mass Before the Wedding
AI-generated for educational purposes. Not a clinical document.
He cannot say the word. He says 'the surgery' and 'down there' and 'the situation,' and his fiancee sits beside him with her hand on his knee in a way that is both tender and firm, as if she is holding him to the chair, to this room, to the fact that they must talk about this out loud. She is the one who found it. I imagine the moment: intimacy interrupted by a discovery that rearranges everything. She does not look away from any of it. She asks about fertility timelines and post-surgical recovery with the practical clarity of someone who has already decided that this is something they are doing together.
He asks me if he will still be a man. He says it exactly like that, with the kind of directness that costs something. I have been trained to answer this question with statistics about testosterone levels and sexual function and the excellent prognosis of stage I disease, and I give him all of those numbers because they are true and because they help. But the question he is really asking is not about testosterone. It is about whether he will be whole, whether the wedding will still feel the same, whether a future child will know. I tell him that I have patients who have run marathons, fathered children, lived full lives with one testicle. I tell him the cure rate is above ninety-eight percent. I watch the number land.
The sperm banking appointment is tomorrow morning and the surgery is next week, and between those two facts is a narrow corridor through which his future family will pass. His fiancee asks if they should postpone the wedding. He looks at her and says no. It is the first time in the visit that he sounds certain of anything.
Lens III
Narrative Medicine: Poetry
AI-generated for educational purposes. Not a clinical document.
She found it first,
her hand in the dark
finding what the light
would have to name
three point two centimeters
of what the body made
without permission,
without warning,
without regard
for the invitations
already sent
he asks me will I still be
and stops
I give him numbers
ninety-eight percent
and watch him build
a floor to stand on