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"When the doctor told Jeff he had cancer, life as we knew it came to a screeching halt," said Amy, 32, a law student who has been married for five years. "It took six months just to get a diagnosis because everyone kept assuring us that Jeff's chronic bladder infections were nothing serious. This despite the fact that he had bleeding, constant pain, and no response to five different antibiotics. The urologist finally agreed to a biopsy because we insisted.
"Three days later the guy called us into his office. I knew it was bad because he wouldn't look us in the eye. When he blurted out the bad news, Jeff turned white as a sheet and I burst into tears. I couldn't believe it! Until this year Jeff was the healthiest person I knew. He runs four times a week, has never smoked, and has no family history of cancer. Bladder cancer is usually caused by smoking or exposure to certain industrial chemicals. Jeff's type, unfortunately, is atypical -- rarer and more serious.
"The following week was a blur of medical appointments. Every doctor thought Jeff's cancer hadn't spread but all said he needed a urostomy -- a procedure that removes all or part of the bladder and creates a new way for urine to leave the body. Impotence is a common side effect -- not something you want to hear at any time but especially not when you're planning to start a family, as we had hoped to next year. As a safeguard, we froze some of Jeff's sperm.
"The surgery went well but at Jeff's first post-op appointment we learned that there were signs the cancer had spread outside the bladder. Once again we were plunged into despair. We consulted four oncologists and opted for radiation therapy. Jeff has to go to the hospital for a 15-minute treatment every day for three months.
"So far he has recovered remarkably well, though of course he's tired and has lost his appetite. We don't know yet if he's impotent. At first he didn't want to tell anyone at his job that he was sick -- Jeff is an investment analyst in New York City -- but eventually he confided in his boss, who encouraged him to take off as much time as he needed. Instead, Jeff has poured himself into his job.
"That's nothing new. He's always been a workaholic, glued to his BlackBerry even on the ski slope. And I've often felt like an afterthought. We had so much fun while we were dating -- on weekends we'd jump in the car and just explore -- but once we were married there was barely time for conversation, much less travel. I felt so ignored that I thought about leaving Jeff, but we went for counseling and about a year ago our marriage turned a corner. Things have been fantastic, and we were excited about trying to get pregnant.
"Then this happened. Now we're back to our old argumentative ways. Jeff will get home late from work, then spend the night online researching new treatments. He's getting care at one of the top cancer hospitals in the world -- does he really think he'll discover something his doctors don't know about? I'll beg him to stop and get some sleep, and before you know it, we'll be in a huge fight. There are days when even a conversation about what to have for dinner turns nasty. I feel him pulling away, just like before. It's as if he's forgotten everything we learned in therapy.
"I want to be strong for my husband but I'm overwhelmed with fear. I can't help thinking, What if he dies? Before the diagnosis I was pretty sure we could handle anything. Now our marriage is unraveling before my eyes."
"I am such an idiot!" said Jeff, 35. "I knew I should have seen another doctor when the first guy I consulted kept brushing off my questions about cancer. I had a gut feeling that something was really wrong but I wanted to believe that he was right, that I was being an alarmist. When the biopsy came back positive I thought I was going to black out. Since then I've been in mental free fall.
"Amy pressures me relentlessly to calm down and stop second-guessing my doctors. If only I had challenged them more, we could have caught the cancer earlier! And if I hadn't pressed for a biopsy, I'd still be in horrific pain with no clear answers. Besides, I earn my living by analyzing and questioning -- I'm incapable of doing anything else. Instead of fighting me, Amy should be supportive. For all she knows I could be one keystroke away from a critical piece of information. Her anxiety makes me feel worse, not better. Yes, I know I retreat into a shell, but I can't help it. I need to handle this my way. It's not like before, when Amy almost left me because she thought I was ignoring her. Marriage counseling helped us through all that. This is different. I'm sick, and I'm afraid.
"She's right about my attachment to work, though. Right now it's the only thing that keeps me sane. It's when I'm away from work that the problems start to overwhelm me. Sometimes I feel as if I'm drowning. I get that same sense of the world closing in that I felt when I first heard the diagnosis, and it's hard to stay hopeful. Amy has to understand that and back off. I know I'm surly and argumentative, but I'm furious! Why me? Why now? Why didn't my doctor figure this out months ago -- and why didn't I push him harder or find another doctor? I was so stupid! My type of cancer has a high recurrence rate, even with the surgery and radiation. The doctors tell me that every person is different, that they don't know what my prognosis is, that they have to wait and see. Well, I tell them I'm still young and otherwise healthy and have no intention of becoming a statistic. I am determined to survive this disease.
"That's on my good days. Unfortunately, I have a lot of bad ones, too. I don't want to scare Amy, but there are nights when I lie awake terrified I'll die or become so sick that I'll be a burden to her. Maybe this time she really will leave me -- and I wouldn't blame her.
"Even if I recover, our marriage could be ruined, anyway. I could end up impotent, incapable of having sex with my own wife! She had her heart set on getting pregnant in the next year or so. Now who knows? That dream is probably shot, too.
"I love Amy. She's too young to have her life ruined because of me."
Recent therapy sessions had strengthened this couple's relationship," said the counselor, "but Jeff's diagnosis left them too overwhelmed to tap the skills they'd learned.
"In a society where sick people are constantly urged to 'be positive,' those unable to see the silver lining may feel like failures. But sometimes the best you can do is hold the other person and say, 'this stinks.' That said, Amy and Jeff needed to focus on what they could do rather than on what they'd lost. They also had to understand that different approaches to the crisis didn't have to threaten their marriage. It wasn't Jeff's nature to calmly accept his fate -- he needed to act to feel less helpless. But their relationship would fare better if he listened to Amy's suggestions -- taking time to rest, for instance. Amy was particularly confused about her role. When she played the cheerleader, Jeff snapped at her. Instead, she needed to encourage him to talk.
"One key skill they worked on was 'checking in' with each other. Its purpose is to find out what a partner needs to feel loved, rather than falling back on past assumptions. 'You'll still fight, but this way, your partner feels prepared, not ambushed,' I said. Jeff especially needed to be able to say how scared he was of dying and know Amy was strong enough to hear it.
"Jeff has been dealt a double whammy: a life-threatening disease that may also leave him impotent. For now he and Amy connect physically through hugging, touching, and cuddling. They still hope to have children but don't want to rush the decision. Fortunately, the frozen sperm gives them leeway.
"To counteract Jeff's depression, I had them begin each day with a gratitude exercise. 'Sit quietly, hold hands, look into each other's eyes, and think about how lucky you are to have each other,' I said. In time Jeff was able to glimpse that elusive silver lining. 'Having cancer has made me reconsider what's important,' he said recently, 'and it's made me appreciate the uniquely wonderful woman I'm married to.'
"'Right now, Jeff is cancer-free,' Amy said. 'That fact alone makes us incredibly thankful.'"
Originally published in Ladies' Home Journal, March 2009.