Many of the couples that I see in my practice grow closer after the diagnosis and treatment of cancer. I describe it as being forged by the searing flames of this dreaded disease. First, comes the terror of the diagnosis and the fear of losing one’s love. I see it in the eyes of the women and men as they sit …
Cancer makes couples grow closer or tears them apart
Ten years ago, I first met this patient, newly diagnosed with intermediate-risk prostate cancer. As I walked into the examination room, I was struck by the juxtaposition of his wife, crumpled in a chair and weeping silently, with the patient himself, pacing the 12′-by-4′ room with a look of either anger or frustration. This difference in response between the man and …
I was sitting in a meeting, listening and participating, but at the same time keeping an eye on my email. I always do this, sometimes to my peril. Email is distracting, and more than once I have been called on to say something and I have no clue where the discussion had gone as I glanced at my inbox. At this …
Yes, cancer kills oncologists too
We’ve come a long way from the 1940s and 1950s when men didn’t cry — not when they stubbed a toe or came back from the war and certainly not in front of strangers. In the last 20-plus years, we have seen a loosening up of the “stiff upper lip,” and we now see men crying in all sorts of places. …
What you think is wrong: Real men cry
My background in nursing has given me a perspective that many physicians don’t have. From the beginning of my career, I have valued the information that patients have provided me about the context of their lives, family, work, and beliefs. I have never cared for a knee or a prostate, but rather I have cared for a person whose life experiences …
The stories that patients tell me are always a gift
Many men experience significant erectile problems after having a radical prostatectomy, and many of the men treated by the urologists I work with eventually land in my office. We talk frankly about the quality of their erections before the surgery, what they are like now, and what they have tried to do to resolve the problems they are having. After this, …
Sharing medications happens more often than we think
I am sensitive to language and the way we use it in health care; as the editor of the Oncology Nursing Society’s premier research journal, the Oncology Nursing Forum, and as a sexuality counselor, words are my business and the tools I use to educate, inform, and disseminate knowledge.
The conversation typically goes like this:
Me: “Hello, can I speak with Mr./Ms. X …
How words create bridges to a therapeutic relationship
The phone rang in my office one morning last week.
Woman: “I received a notice of an appointment with you, and it says to bring my partner or spouse with me. This problem has nothing to do with him.”
(The opening statement could just as easily be from a man, and often is.)
I quickly looked up her notes in the electronic medical record …
After cancer treatment, sexual health challenges are often shielded from partners
Every month or two I see a patient, usually a man with prostate cancer, who is concerned that if he has intercourse with his spouse, he will give her cancer. The question is asked with sincerity, and I can see the worry in the man’s eyes. His spouse is often equally worried but she often looks embarrassed too, almost as …
Shame and stigma in patients with HPV-related oral cancers
I run a dilator program for women with rectal or anal cancer where I educate patients about the need for and correct use of vaginal dilators to mitigate the effects of radiation on the vaginal wall. Many women don’t understand the need for dilators after radiation for this cancer, so I always start with a description of the anatomy and …
A story of how small things really can make a big difference
When is an advocate not an advocate? When should a spouse step back and let the husband make a treatment decision? When should an adult child of a man with prostate cancer let their father decide what is best for him? These are questions that, fortunately, I don’t have to ask all that often. Most men I see for prostate cancer …
When an advocate goes too far in the exam room
We have all seen patients whose distress is off the charts, or off the Distress Thermometer (NCCN). They sit in our offices, dazed and seemingly so depressed that we ask the mandatory question: “Are you thinking of hurting yourself?” Some patients just shake their head, not making eye contact, and even though they say they aren’t going to hurt themselves, we …
Asking patients about suicide sometimes feels out of place
I have written about the support that a partner/spouse provides to someone living with cancer — with prostate cancer and for young adults with cancer — and I always include the partner in discussions about treatment choice or sexual difficulties.
But a number of my older patients are single, and their experiences …
Who said that the older years are golden? They seem pretty grey to me.
My patient mix comes in waves — some months it is mostly women with breast cancer struggling with adjuvant endocrine therapy or men in the aftermath of surgery for prostate cancer. These past two months, it has been young adults, and my heart has taken a beating.
There is something quite different from my perspective between talking to a …
The heartbreak of counselling younger couples after a cancer diagnosis
We all have our fair share of so-called “difficult” patients. And, I would suggest that how we define “difficult” is as diverse as we are as health care providers and as individuals. Some patients come to us with that reputation — perhaps, a vague descriptor in a referral letter or …
Why this provider continues to see “difficult” patients
The patient was a young looking 74-year-old woman, accompanied by her husband. She was not exactly sure why she was seeing me and nodded as I explained that I see all women with anal or rectal cancer who are being treated with radiation therapy. I explained that we recommend that these patients use vaginal dilators to improve elasticity after …
How do you know if cancer treatment worked?
I recently attended the David Stroud Adolescent and Young Adult [AYA] Symposium at Keck Medicine of University of Southern California. It was a very interesting symposium with experts in adolescent and young adult cancer presenting on many different topics important for this population. There was also a panel of young adult …
Should we give patients our cell phone numbers?
A friend of mine died after outliving her prognosis for more than a year. I was with her at almost all her appointments with various oncologists. She had asked me to be the note taker for these appointments so that she could focus on the discussion as it happened and then have the notes to review afterwards.
Her treatment course was …
What do you value most at the end of life?
I have fertility on my mind — and it’s definitely not personal. And it’s really fertility preservation that has me thinking. I recently completed the manuscript of my 10th book — a text for oncology care providers about the provision of psychosocial care to young adults with cancer
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Writing the book was at times frustrating due to the paucity of research and …
The costs of fertility preservation in cancer treatment
Hearing the words “you have cancer” changes everything. In my role as clinical nurse specialist in a busy prostate clinic, I see the effects of these three words on men and their families every day. The shock and disbelief, the fear and confusion as most men feel perfectly well with no symptoms at all. Many men want to do something …
After a prostate cancer diagnosis: The urgency to treat
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