A guy, writing for other guys about breast cancer.
I mentioned “for what it is worth” in the title to highlight that this topic, breast cancer, really isn’t about me or any spouse. My job is clear, support Michelle. End of topic.
Michelle is also a better writer than I am. She’s a Harvard-educated former English teacher; now a writing tutor who helps people fashion strong college essays, among other projects. She could do a much better job writing on this topic than yours truly.
But she, unlike yours truly, is a private person. This turned out to be a first spouse challenge for me, as I wanted to sound alarm bells and build a big support system for Michelle when she got cancer.
But she wasn’t telling anyone. Not even her identical twin sister, Cindy, who likely knows every other detail of Michelle’s life, down to her favorite hair product to tame wildly-beautiful curly hair.
Whatever your style of communicating, it is hard to know how to talk about cancer, much less face it. For her part, Michelle did eventually tell more people, usually on a one-on-one basis. She also gave me permission to write this essay.
Tiring of being in the hospital, Michelle added suggestions to her care coordination board. Her final Discharge Plan read: "Cheering crowds of providers, wheeled to a BMW limousine and taken to Sundara Spa, which is only open to me and 30 of my friends and family."
Breasts
From a husband’s point of view, it is horrible to need to face that your loved one has breast cancer. The most important reason is obvious. The person who you love most in the world is facing something profoundly frightening.
G-d willing, someday we will be able to look back on the barbaric days of cancer treatment, when we had no alternative other than to lop off, radiate, or poison your wife’s living tissue. You would step in front of a bullet to save her, but now there are days when the best you can do is to keep yourself from losing it in front of her oncologist.
OK, let's also keep this discussion honest from the get-go: the less important and less redeeming reason for upset is that we are talking about your wife’s breasts. You love a million and a half things about your wife, and her breasts are on that list.
Your average evolutionary biologists can probably quickly fashion an argument about how breasts are some marker for fitness and procreative potential. However, no explanation seems adequate, or exculpatory for that matter, for the extremes of the male fixation on the female chest. I am fortunate I didn’t have daughters. I might have needed to kill all of their boyfriends.
But would a man leave his wife if she were to lose her breasts? Even for the average chest obsessed guy, that would seem over the top. There are a lot of women, however, telling of fast endings to their long marriages when they came down with breast cancer.
What Does Research Say about Divorce and Cancer?
In her Newsweek article, Why Men Leave When Cancer Arrives, Barbara Kantrowitz summarizes research on the topic. One finding is that when a spouse has cancer or another significant illness, there is a much greater likelihood the marriage will end if the affected person is female. One study found a sixfold risk.
There is also no denying that cancer puts major strains on relationships for both spouses. Much more than solely a biological event, research shows it impacts a range of central life domains: mobility, pain, finances, career, sexual satisfaction, family roles, etc.
For relationships that were already strained, trouble working through cancer together seems to signal it is time to go. Lilli Shockney, RN, wrote that one of her clients came to realize after her cancer treatment that there was one more operation she still needed, a “husbandectomy.”
But I also have good news: While some studies find a higher male rate of spousal abandonment with breast cancer, most large-sample studies, such as these from Canada and Finland, indicate the vast majority of guys do not leave. Divorce rates are essentially the same for cancer and no-cancer cohorts. In the vast majority of cases, we stand by our women.
So we have a statistical conundrum. Most guys don’t leave when breast cancer strikes their wives. But if someone seeks divorce after cancer or another major illness hits their spouse, it is usually the guy.
Six Reasons Guys Are More Likely To Leave
I may be on thin ice here, but I think there are a great many reasons why guys are more likely to leave. I will hit six topics here, but save the biggie, number seven, for the end. My hope in talking about these topics is not to fall into a “what’s wrong with us guys” mentality, but instead to help you think strategically about the struggle ahead. The goal here is to help ensure that your wife, who is probably the very best person you will ever know, will remain by your side.
First, with cancer there are lots of things you want to escape. Research shows guys do more escaping than women. There are fascinating findings, for example, on gender differences in neuroendocrine stress responses. As Verma et al have noted, in both animal and human research, neurological responses during times of high stress are “characterized by ‘fight-or-flight’ in men and ‘tend-and-befriend’ in women.”
You may feel a compelling desire to change everything. To move to a different city and start over. No one wants to live in a house of mourning. Everything around you, every shared memory, is a reminder of what you stand to lose. Who wants to be that guy who lives down the street, known by everyone as the person whose wife has died.
When we are engaged in escape behaviors, we can be very destructive of ourselves. For example, research shows one path into alcoholism is trouble dealing with stress. There are big gender differences in alcoholism, with 20% of adult males affected, compared to 5-6% of adult females.
Secondly, men often struggle with being caregivers. This might feel like a heavy accusation at a time like this, facing cancer. But I think we know even from a young age, the culture pushes a notion of male success focused on professional advancement and being better than others at stuff (not necessarily housework). Michelle has been helpful in being really specific with me what she normally does around the house, and what needs to be done by me. She has also given me some slack about not doing everything her way.
Thirdly, the fact that we are less likely than our wives to “befriend” means we often have less support when our world is unraveling. My great friend Jon flew to Germany, against my wishes, when I was having trouble getting the German authorities to release my son’s body so I could bring him home. It is uncomfortable for me, but I have been learning to say “yes” to offers of support. Jon and our other wonderful friends have walked with us when we have needed them most.
Fourth, guys have a “what’s wrong, fix it” mentality regarding a great many things. A researcher on gender differences in communication, Deborah Tannon, notes we aren’t so great at just listening to what our spouses are feeling. That divide puts us at risk of displacing anger onto others or ourselves when we are confronting a problem that has an unknown etiology and no clear solution. An outstanding blog on listening to each other when a spouse has breast cancer has been made by friends of mine, Cassie and Dan.
Fifth, loss is a setup for maladaptive guilt. I know I am more likely than Michelle to dig rabbit holes for myself. How could this have been prevented? I should have checked the radon in the basement earlier. It was indeed elevated, I learned after her diagnosis, and easily fixed. Intellectually speaking, I might know the radon is more likely to cause lung cancer, not breast cancer, but I feel stupid and guilty as hell. Michelle, bless her heart, now voices the admonition: “If either of us goes down a rabbit hole, the other will chase after them.”
Sixth, there is the sweater problem. Let me explain this one in more detail.
Wearing a Sweater You Can’t Try On
While all major illnesses are challenging in their own regard, breast cancer differs from most in that it often involves plastic surgery or other efforts to regain bodily normalcy. What a tough process.
I am struggling to think up even an infinitesimally challenging guys’ analogy for what Michelle has been through. OK, I much prefer to pick my own sweater rather than receive one as a gift, for example. I know how I want it to look. More than this, before I own it, I want to know how it will feel on my body.
It took a lot of focus for Michelle to collaborate with her excellent plastic surgeon, Dr. King, on a body that she would wear for her life. The really hard part about that process is there was so much outside of both of their control–the internal medical hardware causing a hernia, unexpected infection, etc.
In what felt initially like an odd invitation, soon after her first operation Michelle asked me to come over to her computer to show me a lot of female chests. There were endless pictures of women who had made different surgery decisions. Privately I felt upset to see the scars. I was struck that a great many of the women were smiling, however.
As a husband, you know your wife is going to face an operation that is inherently disfiguring to some degree. We tried to put a good face on it, but there was no escaping that part of her was being cut off. Do you express your thoughts about what might look best, or will doing so insert your feelings (and perhaps, unintentionally, your expectations) into an already hard situation? How do you best support her if she is unhappy with the outcome of the surgery? If she feels less attractive?
Michelle made some of these questions easier for me, as she made it clear she wanted minimal input from me. That, too, was a little hard at first. It was helpful, however, as she took the reins on what she wanted to happen, and navigated decisions related to the ups and downs of surgery in collaboration with Dr. King.
Reason Number Seven: This is Not Really About Her Breasts
Guys, we better than anyone know we shouldn’t be letting ourselves off the hook too easily, but I don’t think the urge to leave the relationship is about our wives’ breasts. If we are more likely than our wives to escape when a major medical illness strikes, we need to ask ourselves “what are we escaping?” I think the answer is death.
When talking directly to death, you face your aloneness. As one of the preeminent writers on the topic, Irving Yalom noted in his text Existential Psychotherapy:
“No matter how close each of us becomes to another, there remains a final, unbridgeable gap; each of us enters existence alone and must depart from it alone. The existential conflict is thus the tension between our awareness of our absolute isolation and our wish for contact, for protection, our wish to be part of a larger whole.”
Feeling that aloneness, it is tempting to leave. And yet there is a tension; a desire to stay and build another chapter in your marriage together.
Death comes for a visit
I am writing this at 3:30 am. I have been awakened by another vivid dream. I wrote it down quickly and went back to sleep. Then I was awakened again by the dog farting. Funny. Now I can’t go back to sleep. The more that I think about it, the more my mind is abuzz with the dream.
Vivid dreams involving my dead son Jack have visited me frequently in recent years. I am not one of those psychologists who makes a lot out of dream interpretation, but maybe I am wrong about that. It seems my mind is writing scenes from a play, one that is relevant to my inner workings.
Some dreams have felt beautiful to me. Many have been nightmares. It is noteworthy to me, however, that when we are together in the nightmares, Jack and I usually prevail by working together. Like warriors, like father and son, we vanquish evil together.
When I learned Michelle had cancer, it felt like Old Man Death was walking into my home again. Was he going to stay or leave? I didn’t know.
As if life was trying to hammer the point home, Michelle was diagnosed with cancer on March 30th, the anniversary of Jack’s death. A year later, four days ago, she had her fourth and hopefully last surgery. Incredibly, again, it was on March 30th.
About that dream: I am having a brief conversation with Death. He is shrouded in darkness, but talks to me in an intelligent conversational tone. He is willing to entertain my questions.
Me: Why did you take Jack?
Death: I might tell you he was too beautiful, too young, too secure in the idea that he was safe. But really, it was just a random vengeful act on my part. I do that.
Me: Why did you give Michelle cancer?
Death: She obviously doesn’t deserve this misfortune. But I have two reasons for what I have done, something involving you and something involving her.
First, I did it to remind you that Michelle’s true beauty has never been about her looks.
Secondly, I did it to show her how strong she is.
With Greatest Gratitude
At this moment, it seems Michelle is going to be OK. Like those women in the pictures, she is smiling when she looks at herself in the mirror. She has big scars. Life does that. But she is walking through life like the beautiful woman she is. She is very alive.
I obviously need to acknowledge that many women are not so lucky. In 2019, 41,342 women died of metastatic breast cancer, for example.
I am also eternally grateful to have a strong marriage with Michelle. We have a new perspective and empathy for how relationships might end under the strain of tragedy, and are grateful that ours has grown stronger instead. We have talked a lot about items one to seven, which has been a help. I didn’t know it at the beginning of this cancer saga, but I now know that I don't give a rip about her body changes, for example. That death is inevitable is all the more reason to live and love to the fullest.
One last area of gratitude concerns her medical team at Dean Clinic/SSM Healthcare. The medical details of Michelle’s fight with breast cancer–what happened to her and how she decided to respond–are important but not particularly relevant to this essay. There are a great many differences in individual situations related to the nature of each cancer, whether it is localized, the possibility of tissue-sparing procedures, chemo, and other topics. I wrote this essay with the hope of being helpful to guys, rather than talking about the details of cancer.
I do want to take this occasion to share one detail of her situation, however. Michelle’s type of breast cancer, Paget’s, is usually quite lethal because it is extremely rare and easily misinterpreted as a harmless rash.
We feel Michelle was quite literally saved by the knowledge and persistence of Holly Guenther, PA, Dean Clinic. At first she thought Michelle had one of those harmless rashes. In a time when people are so busy, and healthcare so demanding, Holly had the intuition that something bigger might be going on. She kept on thinking, called Michelle after hours, and persisted in making sure Michelle was safe.
A team of outstanding physicians also provided truly exceptional care to Michelle, including her gifted surgeons Susan Charbonneau and Cliff King, dermatologist Laura Clifton, oncologist Yamil Arbaje, radiologist Greg Bogost, and internist Randy Haas.
In closing, I want to say that I have written here about male-female spousal marriages. There are a lot of different kinds of families, however. How LBGTQ families respond to cancer is worthy of both study and careful deliberation.
Most Sincerely,
Dan Gustafson