Last week in the ATM machine in the Chase Bank I chatted with an older gentleman who had a trike parked outside. A home made, unmotorized non-recumbant trike with a wire shopping basket on the back. A simple means of self-transporation for someone without an automobile in a town with no bus service.

He was tall and slim and at first glance looked like an athlete. You must be pretty healthy, I said, with all that triking.

No he said, heading for the glass doors with a white-faced glare. Won’t be triking much no more.

Why, I asked.

He told me the rest. He had been to see his urologist in this small town (15,000 people) two or three times or more complaining of blood in his urine. He’s 77 years old. The urologist told him there was nothing wrong with him.

Last week he got an appointment at University of Indiana Medical Center, Indianapolis (the nearest city and the best cancer hospital in that city). They found bladder cancer. He’s booked for surgery in a few days time.

“My daughter asked me, Dad, why don’t you get the surgery here,” he said. His voice was fury, his face was hurt. Never going back to that guy, he said. Never going back to that guy.

I knew that urologist by name, he had diagnosed my husband’s locally advanced prostate cancer in 1991. We did not feel bitter toward him, it was not he but our family doctor who had failed us; and it was this urologist who sent my husband to an immediate appointment with a competent colleague at IUPUI Med Center.

I felt very sorry for this 77 year old gentleman, though; and in view of last week’s news about the study showing that prostate cancer screening did not save lives of men treated at the VA in New England in the 1990s, I wondered, is that maybe how some of it went in VA hospitals in smaller towns in New Hampshire, Maine, Vermont and Massachusetts back in the early 1990s just after the FDA approved the PSA test and before ACS or anyone else would support its use for screening of unsymptomatic men?

This 77 year old gentleman with bladder cancer will go down in his medical records as having been examined 2 or 3 times or more by a board certified urologist before diagnosis. Nothing in the records will mention how he himself insisted over and again that something was wrong. How he climbed on his trike and rode out on the highway over and over to get to that urologist’s office to find some help. How he was turned away, as he told me, mocking the uro’s voice –”Nothing wrong, nothing wrong” — while blood kept coming out in his urine.

If he dies of his bladder cancer — a disease which may be curable if caught early — at some point in the future some Medicare statistician doing a case-controlled, nested study might take his fate as a statistic to show that examination by a board certified urologist does not lower the risk of dying of bladder cancer.

If by then Medicare actually still exists, such a case-controlled, nested study might become political ammunition to show that older, trike-riding men in small Midwestern towns really don’t need to be seen by a board certified urologist. Visits with a urologist are costly. Older, trike-riding men who insist on those visits time after time don’t necessarily gain any benefit in overall or disease specific survival, this future case-controlled, nested study may conclude. These men may as well be assigned by Medicare (if it should still exist) to stay with their local general doctor or maybe a nurse practitioner.

The only trouble I can see in this scenario is where these future researchers will find another 77 year old man not affected by bladder cancer to “match” with this gentleman on his trike — whom I hope to meet again alive and well.