I see patients in three kinds of supportive scenarios. There are those who come to their visits with me by themselves. I understand why they come alone to address their sexual problems; they think that the problem is theirs to fix and often think it has nothing to do with their sexual partner. They’re wrong about this, of course, and when I explain why, they bring their partner for the next visit. I don’t really understand why someone would come alone to a visit when we are going to talk about their treatment choice for prostate cancer. Their partner should be part of that session to understand the extent of their disease and, while they probably shouldn’t choose the treatment for the man with the cancer, they certainly will be impacted by the treatment choice when the inevitable side effects occur.
Most patients do bring their partner with them (we include that suggestion on the appointment notification that is sent to them by mail and this information is provided verbally by the nurses as well). The partner often has a list of questions written out, or perhaps has tagged pages in one of the books we provide to the man at the time of diagnosis. I enjoy getting to know the couple and their values, beliefs, and attitudes. This meeting also has the benefit of them getting to know me, because they will often return after treatment when the man is experiencing sexual problems, and it is easier to get started on that work when both partners have at least seen my face and are a little bit comfortable with me.
And then I see some patients who bring their whole family with them. I have to bring in extra chairs and it can get a little cramped in my mid-sized office. But I love to see men surrounded by the people who love them the most. Because of the age at which most men are diagnosed with prostate cancer, their children are almost always young adults (19 to 35 years old) and the love they exude for their father is almost palpable in the room. It does get a little awkward when the time comes for me to describe the effects of treatment on erections, and I deal with this by warning them that I am now going to have the "sex talk" with their parents and telling the children that they can leave the room if they want. They often do, and the couple and I usually have a little laugh about the expression on their faces as they beat a hasty retreat out of my office.
We all want our parents to live forever. For the young adult, just the thought of the threat of death for this most important man is terrifying. I sometimes find myself supporting the young adult children of these men in a much more intensive way than I do the man himself (with his permission, of course). Even though I provide the statistics about survival in early, localized prostate cancer, family members hear the word "cancer" and death becomes a very real possibility and turns their lives upside down. They often ask if they can contact me for more information, if their father agrees (and I have never seen anyone refuse). What follows is usually a couple of weeks of intense communication—emails, most often, and phone calls, of course. I give my cell phone number to a few who I think really need the comfort of 24/7 access, but this has never been abused (a subject I've discussed in a previous post). Some of my colleagues question why I give out my email address. My response is simple: It takes roughly 30 seconds for anyone to find my contact information online and email is a medium that is controllable; I answer when I want and can respond in a thoughtful manner when I have the time to do so.
Over the last two weeks I have been supporting a family in which one of the parents has just been diagnosed with cancer. The family is reeling with shock, but as each day passes, they are making more sense of the situation and hope is beginning to creep into their reality. One of them asked me why I was being so supportive of them, and was I like this with all my patients, and how did I find the time. My answer was a simple and heartfelt one: I treat my patients the way I would want to be treated if this happened to someone I love or to me. I don’t understand how any oncology care provider could do it any other way.