Cecilia Ford, who has been a psychologist in private practice in New York City since 1987, has addressed emotional issues for us in many articles over the years. This week, she counsels a woman devastated by the decision of her husband, who has terminal cancer, to refuse treatment.

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Dear Dr. Ford:

My husband and I are both 55 and have never had any serious problems, except that we had a small business where we spent 24 hours a day, 7 days a week, overseeing or actually running the operation for 25 years.  We sold the business about six months ago and have just finished helping the new owners with the transition. We had planned a much-longed-for trip to Asia, where our only child lives and works. We never made many close friends, because of our work demands, but we had each other. My husband is a great guy, and has been a wonderful provider and loving husband.

I am writing because my husband, who never smoked, was diagnosed with Stage 4, inoperable lung cancer and has chosen not to have any treatment. He did get a second opinion at the major cancer center in our state, and the diagnosis is accurate. His brother died of the same kind of lung cancer three years ago and was treated aggressively at the cancer center. My husband swore he would never go through the kind of suffering that his brother endured without any significant increase in life—and terrible quality of life.

My husband wants us to take a trip around the world while he is feeling well enough.  I am devastated.  I want my husband to have any treatment that will prolong his life, but he won’t listen to my side of the story.  I don’t know how to be supportive and how to pretend that life is normal when we go on the “vacation of a lifetime.” Am I supposed to do just what my husband wants, since he has been told that he may have only months to live?  I don’t have any support network, and my husband does not want anyone to know about this diagnosis.  How do I cope with this?

Christina

Dr. Ford Responds:

Dear Christina:

Your husband has been given the worst possible news, and as his wife, as you said, you are devastated. Adding to your pain is the fact that you and he have been reliant for many years only on each other, and now you are left to cope with this crisis without the help of a support network. The only help you have had all these years—your husband—is the person whose loss you are facing.

Although his illness is obviously something that targets your husband and his body, it is having a profound impact on you as well. You have described that you would like to, but are unable to, influence his decision to decline treatment, and this helplessness is probably exacerbating your anxiety and fear. Despite your wishes, however, he had has ample opportunity to make an informed decision: a diagnosis with a second opinion confirming it, as well as the example of his brother’s horrible experience with the very same illness. It is hard to argue that he does not know what he is doing.

While it may be difficult for you to imagine enjoying a last (or in your case, first) trip abroad under such conditions, your husband may have a different frame of mind than you do. When faced with their own death, many people are able to make peace with their fate and find themselves able to enjoy their last experiences with considerable acuity. (See, for example, the last lecture of Carnegie-Mellon professor Randy Pausch, in 2007. He was dying of pancreatic cancer. His lecture on what’s important in life became—deservedly—an Internet sensation.) If your husband is free from pain, has your support and company, and you and he are able to visit your child, the trip could be deeply satisfying to him.

Unlike your husband, you are burdened with knowing that afterward you will live on without him, with all the attendant anxiety, guilt, and mourning that will bring. You will probably need professional help to get through this, since you have no support network, and you might start thinking ahead of time about how to rebuild one.

I am not discounting how difficult it is for you to watch your husband make this choice. However, if you stop resisting and instead join him and try to see his last months through his eyes, you will be giving him, and perhaps yourself, a wonderful parting gift.

Dr. Cecilia Ford