When men struggle with treatment decisions

asco-logo It usually starts with a phone call:

“Doc, can I come and talk to you about something?”

The “something” might be erectile difficulties or other side effect(s) from prostate cancer treatment. It might be confusion or indecision about what treatment to agree to. I always inform the caller that any of these issues are better resolved if their spouse/partner is present and then leave it at that. I can make referrals to a pelvic floor physiotherapist for the man who has incontinence issues. I work with social workers who can deal with financial challenges or applications for social assistance. There are always men who want to complain about how they were treated by a member of the health care team and these I can refer to the patient ombudsman who handles these complaints so efficiently. I have a list of marriage and family therapists if after an initial assessment it seems that the couple’s problems are beyond my scope of practice or expertise. Those are the “easy” conversations.

If the man presents for his appointment alone, the discussion is often going to be different. I have borne witness to a great deal of suffering in my office. There are often complaints about a spouse who doesn’t care or cares too much, and I tell these men that they are not going to solve anything alone and that they need to seek help as a couple. Others have talked about feeling alone because their spouse has withdrawn since he can no longer achieve erections and he is terrified and “pretty certain” that she has found someone else. This is hardly ever true, but that is his worst fear — that she will leave and he will be alone. Single men, widowed or divorced or single by circumstance, have mourned what they see as an empty future because no one is going to want a man who can’t have sex.

Men have told me, often tearfully, about rifts in their relationships with their adult children that bring flashes of pain across their face that seem physical. I cannot imagine a reason to ever stop talking to one of my children, but people do things that hurt or offend those that they love and people hold grudges and just can’t let go of slights and arguments. Relationships are complicated, and love is often conditional. There are men who struggle with making a treatment decision, in part because they don’t have anyone that they can talk to. No spouse or partner, no adult child, no relative or friend that they can open up to or trust. My heart aches for them in their loneliness, and while it is not in my power to recommend what they should do, I can certainly listen and ask about their values and facilitate their decision-making process.

In essence that is what I do. I listen. I have the luxury of being able to give them an hour, and sometimes more if they need it and there is no one else booked immediately after them (or it’s my lunch hour that is supposed to be 30 minutes long so not an hour at all). I don’t make notes or type while they talk. I sit, facing them, just close enough that if I want to reach over to offer comfort I can do so. I use the strategy of silence to force them to talk and break that silence. At times I doubt my ability to help; I am a nurse and I, like many of my medical and nursing colleagues, like to fix things for patients.

But not everything can be fixed, and the patient has to live with the “fixing” so he needs to be central to the resolution of the problem. I know that as an objective outsider I can see patterns in how people tell their stories about what they did and how the other person responded, and the solution often seems clear to me but not to those involved. And I have been doing this work for years and have learned a lot about the human experience and how I can help just by listening when I can’t or shouldn’t try to fix the problem.

But how sad to think that some men have no one to talk these things through with, other than a stranger, albeit a professional who is paid to listen. I almost never receive this kind of request from women; they are more likely to talk things over with a friend or family member. But men have traditionally been socialized to be stoic and not share their problems or think that they have to fix whatever is going on without seeking help from others. And so some struggle, at first by themselves and then in desperation they reach out to me. I can only imagine how difficult it is to be in this situation: to be vulnerable and feeling alone when life has thrown you a curve ball or when you can’t fix something in your life as you are supposed to be able to do. And I am honored and humbled to be the recipient of that trust.

Anne Katz is a certified sexual counselor and a clinical nurse specialist at a large, regional cancer center in Canada who blogs at ASCO Connection, where this post originally appeared. She can be reached at her self-titled site, Dr. Anne Katz.

Image credit: Shutterstock.com

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