Breast Cancer: family matters

There's only been one person I wanted to kill in my office, and it wasn't my patient, so it shouldn't count against me. It was her husband. I was talking to her about her newly-diagnosed breast cancer. She was about forty; smartly attired, blond hair trimmed short, she looked younger than her age, and seemed more worried than frightened. Eye contact was furtive, but she was paying close attention. Pretty and prim, businesslike, she listened with care, but seemed distracted. And a contrast with her husband, an open-collar, sports-car sort of guy.

Karen's cancer had been found early, on a routine mammogram, and was highly favorable. I explained the situation in detail, including the likely good outcome no matter what treatment she chose. I told her she needn't lose her breast, that lumpectomy and radiation would have a very high cure rate, equal to mastectomy. But she worried: her breasts were unusually lumpy, and she'd had a couple of biopsies in the past, always scared to death until the reports came back. Knowing herself, she thought it would terrify her to leave the breast in place. Every lump, every sensation would throw her into a panic. She wanted it off.

It was not what her husband wanted to hear. "This is just what my first wife did," he told me. "She died of ovarian cancer. And now Karen is pulling the same shit on me." Wow. What do you say to a thing like that? But he was just warming up. He turned to Karen and said, "I'm telling you right now. If you have a mastectomy, I'm never going to touch you again." When she showed up for her surgery, she was alone.

Mary's husband was the opposite. He'd been with her at every visit, right there at her side the whole way. Young and pretty, she'd had a mastectomy, too, because of multiple tumors within the same breast. At the three-month followup, when she was in the midst of her chemotherapy, they told me she'd gotten a different wig for each day of the week. "I look forward to Thursdays," he said. "That's when she's a redhead."