“Doc, Please Don't Tell My Wife…”
Authors: Anne Katz
Journal: Journal of Clinical Oncology (2011)

DOI: 10.1200/JCO.2011.39.4031 These words cause me to shiver slightly—what is going to come next? As the sexuality counselor at an ambulatory cancer center in Canada, my days are usually filled with interesting patients and their challenging sexual problems. I see many men in the aftermath of prostate cancer treatment, and their desire to maintain their erectile function provides me with an intimate look into the male psyche, which is tender and vulnerable and not all that macho. I see many breast cancer survivors who struggle with the physical challenges of life without estrogen combined with their fear of recurrence if they do not eradicate every last microgram of that nourishing hormone. I see men who have been given the gift of life from a stem-cell transplant, who have no libido and so badly want to be full players in the dance of life. And then there is the man who prefaces his story with the chilling words: “Doc, please don’t tell my wife...” What usually comes next is a request for something that will give them erections that will be used with someone other than their spouse of 40 or 50 years. I keep my face neutral and hear their stories. They usually do not come right out and say that they have a mistress or a “friend with benefits,” but that truth lies just under their ramblings and long pauses. They always want a pill—easier to hide— and when that does not work, they ask me to help them strategize the logistics of pumps or needles and medication that needs to be refrigerated. I listen and suggest and bracket my feelings of discomfort until they leave my office, and I am left with an uncomfortable feeling that permeates the corners of my space. Why did I listen? Why did I help? Why did I hide my feelings of discomfort, and what am I going to do about this moral distress that I feel? You might wonder why I even need to know this about him, and why this does not remain his secret that he shares with no one, least of all a professional stranger. The answer to that may lie in many men’s reluctance to talk seriously (as opposed to jokingly) about their sexuality and my insistence to them that if I am to help, our talk has to be frank and honest. And so it is, and I learn the secrets. I am someone who tries to live an ethical and principled life. And one of those principles is the value that I place on my dealings with others, especially my relationship with my husband of 30 years. Trust and fidelity and love and honor are integral parts of that relationship, and I would bare my teeth and unleash my claws on anyone who tried to disrupt that relationship and the beliefs that protect it. I have read a lot about moral distress in trying to find some semblance of understanding. The medical and nursing literature is replete with articles and studies about what constitutes moral distress and how to deal with it. There is moral distress in lack of resources to care for patients as we want to, and there is moral distress when one provider asks or tells another to do something that goes against their values. There is moral distress in palliative care, in emergency settings, and in every hallway, labor suite, and operating room in the land. There are issues that cause us moral distress that we have all faced at one time or another: a patient’s family member, a son or daughter, asks you not to tell their father or mother that he or she has cancer or is dying. We know how to explain and rationalize and resolve this issue, because we have been trained to do so. But where is the training when you are faced with distress about something that is accepted in our society (people cheat all the time) and yet disturbs you to the core of your being? How do you deal with this knowledge after meeting the patient’s wife who cried in your office when she thought that her husband might die as a result of his prostate cancer and fervently pleaded with you: she would trade sex for his life, any day and any how. And now he sits there, alone this time, his hands clasped between his knees, his head hanging so that you can see the bald spot through the salt and pepper of his hair. “Doc, please don’t tell my wife...” I have no pat answers for this predicament in which I find myself, thankfully not every month, but frequently enough that I wonder about marriage and monogamy after 40 or 50 anniversaries. I have long ago accepted (joyfully, I might add) that sex is not just for the young despite what the media tries to persuade us to believe. Sex continues for many of us well into our 70s and even beyond. But it seems that it is not always with your spouse, and it is often tinged with guilt and despair. I find myself looking for excuses for these men (and they have all been men so far); he comes from a macho culture, his wife JOURNAL OF CLINICAL ONCOLOGY A R T O F O N C O L O G Y VOLUME 29 NUMBER 36 DECEMBER 2