About the Author
Marc Silver is an editor at U.S. News & World Report. He has been a guest on the Today Show, Good Morning America, and various CNN and CNBC programs, and has contributed freelance stories to the New York Times, the Washington Post, and other publications. He lives in Chevy Chase, Maryland.
Excerpt. © Reprinted by permission. All rights reserved.
Unwelcome to the World of Breast Cancer
What to do in those frantic early days
When the news came, I was a husband behaving badly.
It was the last Friday of August 2001. The phone in my office rang around 11:00 A.M. My wife's voice, shrouded by cell-phone static, sounded raw and uneasy. I knew she had gone to the doctor for a follow-up mammogram. A reading earlier that week had raised eyebrows. But Marsha, who was 53, had had plenty of callbacks before, and neither of us was particularly nervous about this one. She thought it was a nuisance that she had to run back to the HMO for what undoubtedly would prove to be a false alarm. Needless to say, I didn't bother to go along.
So my wife went in, unsnapped her bra, and placed her naked right breast in the grip of the mammogram machine. The technician gave the image to the radiologist to examine. A few minutes later, the doctor came into the room where Marsha was putting on her clothes, and with six little words catapulted her into the world of breast cancer: "Sure looks like cancer to me."
Deeply distraught, Marsha called me as soon as she was out of the doctor's office. She wanted to share her pain and to seek some husbandly solace. On a scale of 1 to 10, with 10 being truly superb and 1 being utterly inadequate, my reaction deserved, oh, maybe a minus 11. And I'm being a lenient grader. My wife still likes to remind me of my exact (and insipid) words: "Ew, that doesn't sound good."
We spoke for only a few minutes on that balmy summer Friday as we headed into Labor Day weekend--mainly about logistics (because they're a heck of a lot easier to talk about than feelings). Marsha couldn't see a surgeon until Tuesday because of the holiday. Nothing we could do about that. We decided we wouldn't say anything to our two daughters (they were 12 and 15 at the time) until we knew for sure . . . because the doctor could be wrong, right? And then I said something like, "I'll be home at the usual time." What was I thinking? Yes, what was I thinking?
I'm sure that question must have crossed my wife's mind.
"Women always ask what men are thinking about," comedian Jerry Seinfeld says in one of his monologues. "We're thinking about nothing. We're just walking down the street, not thinking about anything." I believe that was my goal at the time. I didn't want to think about anything.
But, truth be told, my mind was working overtime. Deep inside, I was shocked and scared. I may have been 49, but I felt as if I were 14. I didn't know how we'd muddle through the next 3 anxious days until we saw the surgeon. And if the radiologist proved to be correct, I couldn't even begin to imagine how we'd cope in the months ahead.
YOUR FIRST REACTION
Of all the words in the medical lexicon, "cancer" is the most terrifying, says Jim Zabora, Sc.D., a social worker who has counseled cancer patients for years and is now dean of the Catholic University of America's School of Social Service in Washington, D.C. Breast cancer husbands agree 100 percent.
"You are absolutely shattered," recalls Stephen Peck of Washington, D.C., whose wife, Gayle, was diagnosed when she was 41. "You can't believe it. Why did she get it? She had no family history, no nothing." A ruddy fellow who'd look at home on a golf course, Stephen recalls, "I absolutely bawled my eyes out. You are in total shock and fear because you don't know what's going to happen."
"It was just like somebody punched me in the gut," says Chicagoan Bob Marovich, 39, who felt the lump in his wife's breast before she was aware of it, kept the secret over a holiday weekend, then told her. After having a biopsy, she went for a follow-up visit to the doctor and got the news that the lump was malignant. That's when she called Bob at the office. "I remember not hearing anything else people had to say at work after I heard the news. I went home, and even though you don't want to jump to conclusions, your emotions do."
There's a term for the swirl of emotions you feel in the days after a cancer diagnosis: "acute stress reaction." The symptoms are "shock, disbelief, and numbness," says Margie Stohner, a licensed clinical social worker and consultant to the psychosocial program at Sibley Memorial Hospital's Center for Breast Health in Washington, D.C.
THE KINDNESS OF STRANGERS
In the middle of the hectic early days of breast cancer, we somehow missed sending off a credit card payment on time. Sure enough, we got socked with a penalty the next month.
So I called the credit card company and told them the truth: "My wife was just diagnosed with breast cancer, and some of the bills in the house didn't get prompt attention."
The penalty was erased. And a little lightbulb went on. I realized that although breast cancer was playing havoc with our sense of stability and immortality, it had given us something, too. We had the perfect excuse for all our screwups. So we took advantage. I mean, why not? It wasn't as if we were lying.
"I do tell people, the cancer is taking enough away from you--use it to gain stuff," advises Frank McCaffrey, a clinical social worker who counsels breast cancer husbands at Boston's Beth Israel Deaconess Medical Center. "Maybe your wife is more likely to get seated at a restaurant when she wears a scarf. If it's going to get you a little something extra, why not? Drop it into conversation. People will feel bad and want to make it up to you. And that's okay."
Marsha and I discovered that a mere mention of the disease is a highly effective way to get an annoying telephone solicitor off the line. It's a powerful weapon when you're fighting, um, negotiating with your health insurer. And when a gift card expires because you couldn't get to the store in the middle of the chemo months, there's nothing wrong with seeing if the manager will show a little breast cancer sympathy.
Though the woman is the one who has the disease, the man in her life is inextricably bound up in the emotions of the moment. "I think it's tough to be the husband," says Cynthia Drogula, M.D., who is a breast surgeon in Washington, D.C. Breast cancer patients agree. "Women say, 'I think it's harder on my poor husband,'" says Judy Perotti, former director of patient services for Y-ME National Breast Cancer Organization, which runs a support hotline for patients and their spouses.
Understandably, nobody asks the husband how he's feeling. All the attention is on the wife, and the husband is just expected to be there for her in some vague, undefined way. The same applies to boyfriends, significant others, fiances, and long-term companions, all of whom I think of as honorary breast cancer husbands. Guys, this book is for you, too. (Although to keep things simple, I'll be using the terms "husband" and "wife.")
Some men, like me, don't exactly rise to the occasion when the call comes. Like the fellow who said to his newlywed wife, "I thought you were healthy when I married you." Or the husband whose first question to the doctor was, "What do I tell my friends?" Or the man who sat in the doctor's office with a poker face and his arms folded across his chest, clearly signaling that he couldn't wait to get the hell out of there.
Even with the best of intentions, you might make a fool of yourself. Riding home on the bus with his girlfriend not 30 minutes after the doctor gave her the news, Mike Malone was trying to think of a way to take her mind off breast cancer. Mike knew she was interested in buying a car, so he blurted out, "Want to go car shopping?"
The second he said it, he knew it was just about the stupidest thing he'd ever said. "If there's only one time you forget something I said," he told Stacy, "please forget that." In the 3 years since, she's never brought it up. Mike, now 35, gave her the engagement ring sooner than he'd planned. His message to breast cancer husbands: "No matter what, you're going to screw up."
GUY TALK
"We were raised to take things as they come. We didn't sit and moan and look for excuses and say 'Why me?' When Connie was diagnosed, we just said, 'What are the options?'"
--RAY ELLINGER, 66
Grand Rapids, Michigan
But at least Mike was by Stacy's side. A woman in her 70s once came into the Johns Hopkins Breast Center in Baltimore all alone, to discuss what to do about the cancerous tumor in her breast. "Do you have a significant sweetie?" asked Lillie Shockney, the warmhearted nurse who serves as director of education and outreach at the center, and who is a breast cancer survivor. "No, honey, but I've got a husband," the patient told Shockney. "But he ain't no good."
Or maybe he just didn't know what to do. Although no one has surveyed the hundreds of thousands of husbands whose wives have suffered from breast cancer, I believe that most of us want to be loyal, brave, and loving. We want to be prepared. That's easy when you're a Boy Scout, hard when you're a breast cancer husband. Men are taught to stand alone, to be tough, and to hold in their tears--three traits that don't necessarily add up to a sterling spouse in times of crisis.
MODEL HUSBANDS
If you're looking for a role model, I did come across a few. Some guys just seem to have great reflexes, even when confronted with the news of breast cancer.
Jeffrey Berger recalls the day when he got the same kind of call I did. His wife, Diane, had felt a pea-size lump on her breastbone. Her surgeon did a needle biopsy, and the lump turned out to be malignant. Jeffrey was in his law office when Diane phoned from her doctor's exam room and said, "I think I have cancer."
"Just like that," says Jeffrey, 56. Eight years later, relaxing at his Chevy Chase, Maryland, home on a hot summer Sunday, Jeffrey is still chilled by the memory. "And I said, 'You what? You have cancer?'"
Diane said, "Yes. I'm at the doctor's office and he just got back the results."
Jeffrey said, "I'll come right over." And he did. Jeffrey's father was a policeman, his uncle was a fire chief, and he was raised to follow in their footsteps: Always be ready to deal with an emergency. He knew he had to get to the doctor's office and find out what was going on.
Then comes the hard part: figuring out what to say. You couldn't do better than to take a lesson from Al Shockney, husband of Johns Hopkins nurse Lillie. He walked into his home after a late-night job driving a limo round- trip from Baltimore to New York City. A few days earlier, Lillie had had a biopsy for what appeared to be a cyst. Al, who's got a tattoo on his forearm, a neat white beard, and a twinkle in his eye, was sure everything would be fine. But then, on the long drive home, he began to wonder how he would react if it wasn't. "I knew no matter what the news was I wasn't going to sit down in a chair and break out in a cold sweat," he says. "I didn't want Lillie to see that. I was going to play it real cool. I was going to tell her whatever I could to try to relieve her mind."
Lillie, meanwhile, didn't know what she would say. She practiced in front of the mirror, trying to find the right words to tell her husband that the lump was malignant. And then when Al walked in the door, Lillie blurted out, "I have breast cancer."
Al was very calm, Lillie remembers, and asked, "Are you sure?" She was, since she had seen the biopsy report with her own eyes. Al is one of those rare men who knows just what his wife needs to hear. "I have known you a long time," Al said. "I know you are strong, with a zest for living, and we are going to be here for each other; we are going to be fine." Lillie's puckish eyes still tear up, 10 years after this conversation. "It was very convincing," she says.
At the time, Lillie didn't know what was really going on in Al's mind: "I was scared to death when she told me. My life flashed before my eyes, and everything was going by so fast. I actually wanted to cry."
Sitting in her cozy living room, Lillie laughs. "That would have been really bad for me if you did--really bad!"
BIOPSY TIME
Whether your wife's lump was found through a mammogram, a self-exam, or a doctor's exam, she will need a biopsy to learn if the lesion is benign or malignant. In Marsha's case, the doctor performed a surgical (or excisional) biopsy. This outpatient surgery takes about an hour, but there's inevitable waiting time built in. The woman enters a twilight sleep with anesthesia delivered by IV. The surgeon cuts out all or part of the lesion, which a pathologist assesses for cancerous cells. After some of the grogginess wears off, the patient is released. She'll miss a day of work if she has a job. Biopsy results are available after several days. If the lump is malignant, the patient will then face a second surgery to remove the tumor with clear margins--that is, leaving no cancer behind.
At the time, Marsha and I didn't know there are other types of biopsies that are a lot easier on the patient: fine needle and core needle. In both cases, the needle removes a sampling of cells. The needle is a little smaller with the fine needle biopsy, which dislodges cells for examination. Cecilia Brennecke, M.D., director of breast imaging at the Johns Hopkins Breast Center at Greenspring Station in Baltimore, prefers the core biopsy, which employs a slightly larger needle. Guided by ultrasound or x-rays, the doctor removes a core of tissue from the tumor. In Dr. Brennecke's view, the result is "a much more accurate sampling" than with a fine needle.
In a needle biopsy, a local anesthetic is used. The biopsy takes about 30 minutes to an hour. Husbands sometimes come along, but Dr. Brennecke suggests they stay in the waiting room. "I think it's difficult to look at a needle biopsy," she explains, remembering one husband who fainted.
A pathologist will test the tissue for cancer. (You might want to ask how often the pathologist works with breast tumors. Weekly is an acceptable answer. Daily is even better.) Results typically come back in 1 to 3 days. Voila: biopsy results without undergoing a surgery.
