What my patients taught me about love.

DOI: 10.1200/JCO.2009.22.5755 I was on a quest to learn the secret to marriage. I specialize in treating older adults with leukemia and conducting research in this disease. The “youngsters” in my practice have been proud members of the American Association of Retired Persons for 15 years. The old timers, still part of the “greatest generation,” come to appointments with their newly-retired children. My friends, family, even my own patients ask me how I can face leukemia—that malignant golem everyone else avoids—every day. The truth is, it’s easy, and somewhat selfish. I am constantly surrounded by people who have rearranged the priorities in their lives to focus on what’s really important: appreciating the nuances of a random day, their friends who drive them to and from appointments, their children and grandchildren, their husbands or wives. It’s rare that I hear complaints about the traffic coming into Cleveland, or the quality of the free coffee machine in the cancer center lobby. And I learn so much from my patients about an era that preceded me. The transfer of information that occurs in clinic is bidirectional. I try to speak clearly, often loudly, about the pathobiology of stem-cell malignancies and their therapies, using metaphors of kids going through school and of armies and a bunker mentality. My patients tell me the history of the steel industry, and what happened to the Packard auto plant. I learn how cardboard boxes are made in Erie, PA; what wood to use to build a quality jewelry box; and what makes the red color on the taillights of cars (turns out, it’s doxorubicin). But mostly, I learn how people relate to each other when they have been together for more years than they have not. So I started to investigate the secret to a long marriage. I mean, who better to reveal the answer than a couple facing a cancer diagnosis, people who may have drawn closer as the potential for death nears? Naturally, being a researcher, I was fairly scientific about the whole process. No, I did not have this study approved by our institutional review board, as at the time I had no idea I would publish the results, and frankly didn’t recognize that I had embarked on the study until I had already asked the same questions of a few couples. I was only allowed to query a couple who had been married 40 years or longer. Both husband and wife had to be in the room, and each had to be healthy enough to answer on his or her own. Sometimes this was difficult— apparently, if a man lives to the age of 80 years, teleologically it is to his survival advantage to let his wife answer for him from that point onwards. But I did my best to make the process work. I would walk into the clinic room; ours are sparse—shades of white and beige with an exam table, small gray table with a computer, and three chairs; sometimes with a window, sometimes not. About half the time the couple sits next to each other, the other half across the small room from each other. This is no reflection of their feelings toward one another; I guess that as you age, you regard the placement of furniture as something that is handed down from the Mount, and inviolate. I start the interview, asking questions about fatigue, shortness of breath, visits to emergency rooms, and medicines for the heart. When we get to the social history, I ask how long the two have been married. “Fifty years, God bless ya! So, what’s the secret?” A look of surprise. By this point we’ve gotten into a rhythm of my asking questions and my patient (or his wife) answering, none of this particularly emotional. But now I’m asking him for an answer on which he’ll have to reflect, and I’ve altered the power relationship; this is no longer doctor questioning patient, but younger person asking someone more experienced. He shifts in his chair, sits a little straighter, smiles, and gives me his response. What follows are the quantitative, nonparametrically analyzed, unvalidated, and completely informal results of my study. Approximately 40% of the time, my patient gives the easy answer, the one you always hear: “You have to have a sense of humor.” Of course you do. You can’t make it very far through life without a sense of humor. But was that the key to a long and happy marriage? Or was he just being polite, and really saying, “Hey doc, let’s get beyond this marriage discussion and talk about my cancer, will you?” I reminded myself also that this generation has the tough guys, who shy away from displaying emotion and put on an unflappable front to protect their wives—Clint Eastwood in his prime. Still, I always found this answer genuinely unsatisfying, but maybe my standards were too high. JOURNAL OF CLINICAL ONCOLOGY T H E A R T O F O N C O L O G Y VOLUME 27 NUMBER 28 OCTOBER 1 2009