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 still 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 with the spouse or partner who has just found out they have cancer. Then they tell me, often in a tear-soaked whisper, that they would give up anything and everything just to keep their beloved alive. I nod and often reach out with my hand to soothe, as if it were even possible in that moment. I know I will see these couples again, when the trauma of diagnosis has passed and the memory of surgery or radiation is beginning to dim. Now they can laugh together, about his fear of the knife and her anxiety that he would not come home to her.

They weather the days and weeks and months that follow, some better than others. The loss of connectedness, the true meaning of intimacy, is challenging, but with some help, they begin to talk. I sit in my chair and see tears fill the eyes of men who last cried when their babies were born. This is a strange feeling for them and they ignore the proffered box of tissues, choosing instead to wipe their eyes with the backs of their fists. The women tend to cry more easily, apologizing all the while, but tears do not shame them. I understand. Over weeks and months they craft a new togetherness, one that is circled by talk of shared emotions and new pleasures. They have grown, and in their growth I learn life lessons for myself, although this is never the intent. I learn about grace and words and gestures that bridge the gap between passion and loss, fire and rain.

But then there are those for whom the cancer portends a much greater risk. There are those (they are usually women) who first come to me on their own despite instructions to bring their partner to our meeting. I listen for the red flags behind the halting requests of these women to fix them, to make them whole, to somehow make the years after menopause go away. These women seek out the skills of the plastic surgeon to create a body that is not theirs, is better than theirs ever was.  I gently ask them why. With shoulders squared, I hear stories of past transgressions—his, not hers—of relationships hard fought for with the constant threat that he will do it again, will seek out someone new, someone younger, someone more something or other. These women have forgiven, some many times, or have pretended not to know the truth behind the late nights at work, the sudden trips to… where? They tell me without speaking that there have been silences between them, some weeks long, when they wanted to ask “Who is she?” but were afraid to hear the answer.

These couples walk a tightrope of mistrust and lies told over the years until she stops asking, stops thinking, perhaps even stops caring. There is the house, the grandchildren, the friends who know but never ask. The fear of losing it all, the money too, keeps them accepting, silent, in hurtful ignorance. These couples did not draw together as she healed physically from yet another surgery to make her breasts those of the 22-year-old he craved all those years ago. Her stomach is tight afterwards, but a scar stretches just below in painful imitation of a smile. She still dresses and undresses in the closet, afraid that if he sees he will reject her and she will have experienced all that pain for naught.

The men hardly every appear for our sessions, despite my warning that the women are not going to fix anything without them. They keep coming back alone—he had a meeting, he was going to come, he refuses to come.

My better judgment falls prey to sadness and I sit with these women, tissues offered and accepted, as I listen to the stories. Not for these women the gift of acceptance, of love given and received. For them there is the lonely song of compromise, of making do, of keeping up appearances outside my office walls. I learn lessons from them too, but mostly I wonder at their fortitude, their forbearance, and their suffering.

Cancer makes some couples closer; I wish it were so for all.