“You can’t cross the sea merely by standing and staring at the water.” —Rabindranath Tagore
“Cassidy,” 29, had a mastectomy and axillary lymph node dissection for stage III breast cancer six months ago. She finished chemotherapy a couple of months later and will soon be done with radiation therapy. Ever since her diagnosis, she feels like her life has been a whirlwind of medical appointments, medications, and side effects. The day before her diagnosis, life was normal. The words “You have breast cancer” transported her to a foreign place: Cancerland, where nothing is familiar and nothing makes sense.
Cassidy feels completely overwhelmed and exhausted. She tries not to let it show, though, because she feels everyone around her has supported her as much as they can and she shouldn’t ask for anything else. In fact, people have as much as told her that they expect her to be back to normal as soon as her radiation treatments are finished. Part of her thinks this is an unrealistic expectation, but part of her wonders if maybe there’s something really wrong with her because she is so far from feeling “normal.”
Cassidy has tried to talk to her husband, “Dave,” about how she is doing, but Dave doesn’t listen. Instead, Dave tries to come up with solutions for how to solve the problems. This is typical. Men are fixers. They want to make things better for their wives/partners. Not being able to do so makes them feel frustrated, angry, and inadequate. So, Dave tries to show he cares by offering solutions. Cassidy sees this as not listening to her feelings, meaning Dave doesn’t think her feelings are valid. Cassidy talks about her feelings more to try to be heard, and Dave offers more solutions that Cassidy doesn’t use. As neither person feels heard or appreciated, they begin to pull away from each other.
In addition, though Dave hasn’t verbalized it, he has thought about what it would be like if Cassidy died of breast cancer. This is terrifying to him, and causes him to distance himself from her somewhat, thinking it will protect him in some way. Dave hasn’t tried to make love to Cassidy since her surgery because he is worried about physically hurting her and is a little “freaked out” about her chest after the mastectomy. The last thing he wants to do is hurt Cassidy’s feelings, so he hasn’t shared this with her. He thinks he would get used to the scar just fine, but Cassidy never lets him see it. He doesn’t think Cassidy ever looks at it, either.
Cassidy’s view of herself has changed significantly since her mastectomy and treatment. Being on tamoxifen (an estrogen-blocking agent) has put her into menopause. She has hot flashes, mood swings, and vaginal dryness, which are all associated with low estrogen levels. Her libido is gone, and she can’t imagine how her husband could find her attractive anymore. She thinks her chest looks hideous. She assumes her sex life with Dave must be over. On one hand, she’s so exhausted and uninterested right now that she’s kind of glad he’s not initiating anything, but she’s hoping it’s not always going to be like this. Will she ever feel feminine and/or desirable again?
What Cassidy and Dave need to know is that everything they are feeling is absolutely normal. Breast cancer affects a young woman’s sense of herself in all areas of her life: her body image, self-image, and sexual identity. It impacts her role as a mother, spouse/partner, and as a woman, both in personal (i.e., dating) and work situations. It affects her career by having to take time off for treatment, and if she doesn’t have excellent health insurance, it affects her life by impacting her income while she is off work and by the significant cost of cancer care. Additionally, cancer affects the entire family, not just the person with the diagnosis.
Young women have more distress with all of the above issues and with living with uncertainty than older women. It is crucial that they find a way to communicate with their spouses/partners so they can move forward from the trauma and disruption that breast cancer has created in their lives. Some of my previous blog posts have addressed how to communicate with your spouse/partner, as well as cancer and sexuality. If you are unable to work things out on your own, you may want to consider seeing a therapist. Breast cancer will change your life in some ways, but it doesn’t have to change your life in all ways.
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