Dear Sars,

I stumbled into a problem and I’m way out of my depth.I’m hoping you or your readers will have some advice for me.

My husband comes from a family with a history of cancer.He lost his sister very young to a rare sarcoma, his dad’s got a brother who’s spent his whole life having tumors removed from his head, and his paternal grandmother died fairly young also, I think of leukemia.The other day I got it in my head to wonder whether there’s anything more to this than coincidence.

Thanks to the wonders of the Internet, I now know that his dad’s family fits clinical diagnostic criteria for a rare genetic condition called Li-Fraumeni Syndrome.Affected individuals have a 90% chance of developing one of about a billion cancers.My husband’s chances of being affected look to be about 1 in 2.There is no survival benefit to knowing whether you are affected — additional screening has not been shown to benefit anybody, since you’d have to screen for basically everything — and there is no cure.

The obvious thing to do at this stage is to see a genetic counselor, and I’m planning to call one.I mean, I have a strong enough scientific background to be pretty confident I understand the heritability stuff here, but I’m still not a doctor.Nevertheless, the issues are complicated.

There is a genetic test, but they’ll generally only do it if you can produce a living relative who’s affected, so you know which mutation to look for.The only living relative with cancer has a brain full of holes, making consent a complicated issue.My father-in-law has never had cancer; since my sister-in-law died of it it seems logical to assume Dad’s carrying the responsible allele, but I don’t think they go on genetic fishing expeditions in healthy people whose sick relatives haven’t had the genetic test, and all the cancers in their family emerged when this syndrome was still new to the scientific literature.

And it makes sense to eschew the fishing expedition — a positive result, as I said, confers no survival benefit; and a negative result, particularly when you don’t know which mutation is the problem, is uninterpretable.

So here’s my question.Assuming that a genetic counselor agrees with me that this sounds like Li-Fraumeni — what the hell do I do with that information?I haven’t mentioned a word of this to my husband and I don’t know what my ethical responsibilities are.My instinct is that because knowing can’t make his life better and could make it a lot worse, I should say nothing.He does not handle death well, to say the least, and not infrequently wakes me up at night with night terrors about mortality.

But we’d been planning to have kids within the next couple of years, and — now what?I can’t really reverse course on that with no explanation.But finding any answers relevant to our hypothetical kids would mean involving the whole family, and that is an awful lot of shit for an in-law to stir up in the lives of people who already haven’t had it easy.

And oh, Sars, nothing in life has prepared me for the loneliness of this knowledge.Nothing’s changed, and yet everything feels different, precarious and raw.The worst part is that we’re not even living together right now — I took a one-year position far away from him for the sake of my career, figuring one year was a small fraction of the rest of our lives.Now that I’m no longer sure that’s true, I find myself hating and fearing every day we’re apart.And I don’t know who I can talk to about it, or what to say.

Sign me,

I Didn’t Expect To Be Contemplating Widowhood Before Thirty

Dear Thirty,

The first thing you do with the information, if anything, is share it with your husband.Given that the two of you wanted to start your own family in the next couple of years, you have grounds — grounds for researching the condition; grounds for wanting to discuss it with him, because of the possible implications for your future offspring; grounds for involving the rest of the family for the sake of your own.Yes, it’s a lot of shit for an in-law to stir up, but if it involves the health and life expectancy of your children, well, that’s shit your husband should want stirred too.

But your husband has to want to do it, armed with the relevant information — and it’s not really for you to go see a genetic counselor on a fact-finding mission.I understand why it seems like a good idea; I think that, presented with a problem that you really can’t control, you’re trying to manage it by collecting information.But you’ve already seen that knowledge is not necessarily power, and that learning more isn’t making you any happier or fixing anything; ignorance was bliss, in this case.

And again, it isn’t you who’s maybe got this syndrome.It’s your husband.If I found out my significant other had gone over my head to a doctor to discuss my melanoma profile, I have to tell you, I wouldn’t love that.I’d be touched by the concern, and the effort, but I don’t really want people diagnosing me without my knowledge.

Sit your husband down, tell him what you found out, and then just listen.Do not suggest the genetic counselor, do not utter sentences that start with “I think you need to”; tell him that you got curious, so you did some research, and now you can’t un-know these things and it’s got you worried about the consequences for your future kids.You want to avoid speculating without proof, or getting too far ahead of yourself as far as the repercussions, because he’s just going to feel overwhelmed, and you can get to the “I’m afraid to waste too much time living in a different city from you” part of the conversation later.Give him a chance to talk.

It wouldn’t be a bad idea for him to see a counselor — a psychologist.His family has had a rough go, and if he’s waking up with night terrors, he should consider talking to someone about that and managing his anxiety more productively.

That is for him to do, though.I do think you should tell him what you’ve found out, because medical ethics aside, the emotional ethics of the marriage dictate that you not be profiling him on Web MD without telling him.But most of this is on him, and you have to give him a chance to step up to that.

Hi Sars,

This is long, for which I apologize, but I’m hoping someone outside the situation can help me out.

So there’s this guy. Not like that, actually. We’re married. We dated for 4 years, married, and it was great. I’m 28 and he’s 33. My family loves him, he loves them, we love each other, I love his family, they love me.

However, right after we got home from the honeymoon, his mom was diagnosed with cancer. We spent the next year and a little bit dealing with a long, drawn out, horrible series of tests, surgeries, chemo, radiation, screwed-up surgeries, narrow escapes, and finally, on our first anniversary, we were told there was nothing more they could do for her. It was awful. We were told 1-2 weeks, and she held on for almost 5. It was incredibly painful for everyone.

My husband, we’ll call him Will, had been very close to his mother, and this was especially hard for him. He was taking care of his father, I was taking care of him, and my family is 3,000 miles away, so I just sort of worked by myself to keep everything together. Understandably, my husband was very angry at the world and the situation and everything, and, also understandably, he directed it towards me. I know it’s like when you’re a teenager and you take things out on your mom because you know she’ll still love you, so she’s a “safe” person to get mad at and be mean to. He did that to me, big time. I tried talking to him about it a few times, but that tended to make him defensive and angry, and wasn’t really worth the grief. So I just put up with it. Besides, his mother was dying. I felt that kinda gave you a pass on just about anything.

Friends were aware of the medical situation, and some knew that he was being kind of nasty to me, but I didn’t tell them all of it, because we have the same friends. If I told them, I felt like I’d be changing their relationship with Will, ratting him out or something. Same reason I didn’t explain it all to my mom — if Will and I split, then I could explain it to her in a way she’d understand, and if I told her and we stayed together, then I knew she’d have a problem with him forever.

But the truth of it is that he was emotionally and verbally abusive. He was controlling and jealous, he wouldn’t let me out of the house without him, he was possessive and cruel and seriously not okay. While it was going on I did a pretty good job of not thinking about how nasty it was, instead just working to get through each day and keep everything and everyone together. He said a lot of horrible things, called me names, blew up at the slightest setback or bump or if anything wasn’t perfect. He would insist on driving me places and picking me up, which put me in the situation of only going where he would take me, and only for that long. Anything that went wrong was my fault, and he made me feel like shit. Pretty classic examples, really. This lasted for a year and a half — the first year and a half of our marriage, no less.

And recently he’s sort of snapped out of it. He’s had some time to deal with the grief, and he’s getting back to being the nice, caring, fun guy I fell in love with. The problem now seems to be me. I’m scared of him. I’m petrified whenever there’s another bump in the road, and I find myself still scrambling to make sure everything is perfect for him because I worry about his reaction if it’s not — even after he’s shown himself to be mostly sane these days.

I’m especially worried that this sort of thing will happen again. His father is, some day, going to die. He’s back in college working on a medical degree, and that’s stressful, and he might, I don’t know, fail a class or something. How do I know he won’t go abusive asshole again?

I’m also angry about it. Now that there’s not the immediate worries of taking care of my wonderful mother-in-law (to whom I was very close), or keeping people from completely losing it, I’m pissed. I’m angry he was such an asshole, I’m angry I never really got to mourn for her properly because I was too busy taking care of him, I’m angry that this shit isn’t behind us already, I’m angry, bizarrely, that he’s fine now and I’m not. I’m really angry that this happened, that he treated me this way, and that our marriage is fucked up.

I also panic when he does get angry now. I think I had a full-on panic attack once, and in general I just feel like I’m on eggshells around him, worried that he’ll be upset again. It doesn’t feel fair to ask him to never ever get mad, but I don’t know how to calm down when it’s been so strongly associated for the last 18 months that him being angry means a lot of yelling, slamming things, nasty words, and pretty scary misery.

He’s being very nice and supportive, and feels very bad about how he treated me. He doesn’t remember lots of it, which is kind of worrisome, but I know he was freaking out. He’s told me I can talk about it, and encourages me to do so. I still worry, though, that this is going to happen again. He didn’t think he was being unreasonable at the time.

It’s a little hard to phrase my question here: Is my worry that he’ll do this again valid? Can he really not do this again, or is it hardwired in there somewhere? Is he going to do this again when life gets super-stressful and so should I just get out now? Am I willfully missing signs that he’s going to start hitting me someday? Should I get myself to a shrink because I’m a basket case and everything would be fine if I’d just get over it already? Something else I’m missing?

I just don’t really know how to deal with it, or get over it, or entirely even if it’s something I should get over. Any help, from you or any readers ever in a similar situation, would be really, really helpful.

Eggshells

Dear Egg,

Yes, the worry is valid.Not written in stone, no, but valid nonetheless.Sure, maybe he’s past it for good, and I don’t know that he would start hitting you, but when you look at the ingredients, nothing in the recipe has changed.Life is still full of stressors and hard times; Will hasn’t dealt in any meaningful way with the fact that he reacted to those by becoming abusive; you still make excuses for him and blame yourself.

This isn’t your fault.You didn’t know what else to do, and then you didn’t know how to stop doing it, or when, and I think anyone else in the same situation could have had a similar reaction, feeling like she didn’t have the “right” to stick up for herself given what he was going through.

But Will didn’t have the “right” to treat you like he did, regardless of the other emotional issues on his plate, and anyway, it doesn’t matter who had what “rights” — his behavior has had its effect, and you’ll have to deal with it together.

Tell him what you told me, in abbreviated form.Tell him you love him and you want the marriage to work, but you feel like you can’t exhale around him, and the two of you need to find a better, happier way to work through the tougher times, because you can’t go through treatment like again — and won’t.You both need to go to therapy, separately and together, and you need to make it clear that this isn’t optional.Try not to sugarcoat it, or talk yourself out of taking a firm line because you don’t want to hurt his feelings, or he had his reasons, or what have you — reasons aren’t excuses, controlling your movements is not in fact a normal response to grief, and the fact is, you’re afraid of him and you resent him.You put up with a lot of shit for his sake; now, for yours, he’s going to get some help so that the two of you as a couple don’t end up back in this crappy place the next time he suffers a setback.

So, yes, get yourself to a shrink, but it’s not because you’re a basket case.It’s because you deserve better than this, and so does your relationship.Sometimes we get in a rut with our actions and reactions and a third party can help pop us out; give yourself a break, and ask for what you need.

Dear Sars,

Quick grammar question. My friend is always saying “I feel nauseated” or “I’m nauseated.” I keep hearing other people say “I feel nauseous” or “I’m nauseous.” Which of these is correct?

Feeling kinda queasy myself

Dear Quease,

I covered this in the very first letter here.(Don’t forget TN has a search function!)

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