What's the job of a caregiver when it comes to breast cancer?
 
The motto of a caregiver should be: shut up and listen. In other words, when the wife wants to tell her husband how bad she feels, he doesn't have to cheer her up. He should empathize, and say, "I know how bad you feel, but we'll get through this together." Karen Weihs, a George Washington University psychiatrist, has done two small significant studies of women with breast cancer, and found that the women who felt it was natural to be distressed because of the diagnosis, and who were frank about their feelings–in other words, who weren't shy about complaining–coped better and lived slightly longer than you'd predict based on their prognosis. Oh, and one more thing: husbands should stay away from sports analogies. Don't say what one fellow told his wife, "It's the bottom of the ninth and there are two outs, but we're going to hit this out of the park." If there were a breast cancer umpire, he'd throw that guy out of the game.

Do men who walk out?

Everyone knows a story about a horrible husband who abandoned his wife after she was diagnosed with breast cancer. Unfortunately, there are some men who are such scumbags that they'll walk out the door and never come back. Sometimes the marriage was already in trouble. And sometimes it seemed just fine until the cancer crisis struck. Then there are the guys who send clear signals that this wasn't what they bargained for when they said "I do"-like the guy who told his newlywed bride "I didn't think you were sick when I married you" and then wanted to know if she could postpone her mastectomy until sailing season was over. (She gave him the old heave-ho.) The deeper truth is that most marriages survive the trial by cancer. Many husbands rise to the occasion in ways that surprise their wives. And many couples report a deeper bond of love after the treatments end. As for statistics, there's a well-regarded study out of Quebec that looked at 200 breast cancer couples and a similar number of couples of similar ages in the general population. About 1 in 10 breast cancer couples reported marital dissatisfaction after treatment had ended-the same number of unhappy couples in the non-breast cancer sampling.

Who should tell the kids, mom or dad?

This shouldn't be a job just for mom. Dad is going to be the go-to guy during mom's recuperation from surgery, and during chemotherapy, if it's needed. If mom is too overcome with emotion, Dad might do a solo act. But the ideal is to have both parents talking with the kids. And yes, they should use the word cancer (if you don't someone else will) and the word breast (no matter how many giggles it elicits, that's where the cancer is).

Should a guy tell his wife how scared he is?

Seems like a straightforward question. But it turns out to be very complicated. In the community of therapists, the bias is toward "self-disclosure." In other words, share your emotions. Don't keep them inside. But many women told me that they wouldn't have wanted to hear how scared their husbands were by the breast cancer diagnosis. My own wife said that if I'd told her how frightened I was (and I was pretty frightened at the start), she'd have thought I knew something she didn't know. So it turns out that sometimes it can be a kindness for a guy to keep his feelings inside, or confide them to a very close friend. With time, his fear may lessen. And sometimes it's perfectly fine for a guy to say, "I'm scared, too"-as long as he adds, "But you have wonderful doctors and I believe them when they say your odds for a successful treatment are good."

Do breast cancer husbands cry?

Well, I did. I cried in the car one Sunday afternoon, when the sky was blue and the sun was shining and Ray Charles came on the radio singing, "America the Beautiful." It was about two weeks after my wife was diagnosed (and just a few days after 9/11). And I don't know what happened, but suddenly I heard these strange sounds in the car and it turned out it was me, sobbing. And it felt good. Turns out a lot of guys cry in the car. Randy Harper, whose wife fought breast cancer for five years before dying in 2004, told me how he would get in the car in the morning to drive to work and have his "feel sorry for me" time. He'd curse the windshield and he might shed a few tears. Matt Wey told me how he sat in his car in the hospital garage after his wife's mastectomy and cried. Wrapped in two tons of steel, you're invisible from the world's eyes and you can cry your eyes out (just make sure you can still see the traffic lights). And some guys told me they cried with their wives. The two of them sat in a chair and sobbed at the news of diagnosis, and, like they say, there's nothing like a good cry.

Does humor help?

Funny, it does. There's even a study to prove it, by psychologist Sharon Manne of the Fox Chase Cancer Center in Philadelphia. Couples who laughed at cancer coped better with the stress of treatment. Of course, there are no rules as to what jokes work and what jokes won't work. And you're playing a very tough room. Brenda Moyer laughed when her husband, Dave, called her "boobless in Macungie." Carol Stevenson thought it was pretty funny when her husband told her every time he saw saw her bald head and sunken eyes during chemo, he had the urge to go bowling. But other women told me they would have felt deeply wounded by jokes about their baldness. All I can say is, stick to your style as a couple. If the two of you traded gentle jokes before cancer, keep it up. And if a joke doesn't work, apologize and move on. And remember, if humor doesn't help, flowers always do.

What should a husband do in the doctor's office?

Many men think they have to run the doctor's appointment as they might run a meeting at work. Bad idea. The woman is the patient. The doctor should make eye contact with her, not with her husband. He can take notes, he can gently prompt her to ask questions, but he's not in charge. His physical presence is a boon. There's a study that shows couples who held hands before the stress of delivering a speech had lower heart rates and blood pressure than couples who didn't hold hands. He can be the keeper of the films-because your wife might have to shlep her mammogram films from doctor to doctor. And if the doctor is a chauvinist, his presence might get more attention for his wife. But most of all, just by being there he gives his wife more power. Instead of feeling intimidated by the doctor, she has her husband by her side. She may feel more confident about asking questions and expressing her opinions. Of course, there are exceptions to every rule. One woman couldn't stand going to doctor's offices. She put her husband and sister in charge of everything. At one appointment where the goal was to gather information, she sent the two of them and went to work instead. The doctor was a little surprised. But today, the woman is doing just fine.

What can a husband say to his newly bald wife to make her feel better?

"You look beautiful to me" is a good start. If you heap on too much praise, she might think you're lying. (Women know that kind of thing.) But when you look at your wife's face, it's still the same face. John Salamone taped a "bald is beautiful" sign to his wife Jeannine's mirror. And when my wife was embarrassed to take her wig off before the two of us got, um, intimate, I told her, "Honey, it's me." She was as shy as a teenager on a first date, but she took of the wig. And you know what-she looked beautiful to me.

Should husbands shave their heads in solidarity?

Totally up to you. I didn't. Some guys do. The best story I heard was from Vern Taylor of Winnipeg, who took a razor to his white locks. Vern wasn't sure who he should tell about his wife's disease. After all, cancer is a private condition, and a breast, well, that's a private part. But then he came to realize that breast cancer touches so many people, and it's okay to share the news. And he figured a middle-age guy with a shaven head would prompt curious questions-hey, dude, where's your hair? Which it did. And he told people about his wife's breast cancer, and people shared their stories of how breast cancer had touched their lives.

Um, what about, you know, sex…

Isn't it funny that doctors don't always talk to breast cancer patients about sex. Because the breast is a sexual organ, you know. But when a doctor is working to save a patient's life, maybe there just isn't time for a conversation about intimacy. What I've learned is that breast cancer is not a sentence to celibacy. Now chemotherapy doesn't put anyone in the mood for sex, but in those few rare days when your wife might be feeling well, there's nothing wrong with coming on to her-very gently. Because as my wife reminded me when I was writing, the only way the woman should consider having sex at that time is if she feels up to it and wants it. And lubricants really help, because vaginal dryness is a side effect of chemo. If your wife isn't interested, then maybe she would like a good cuddle. "The loss of touch is the biggest loss there is" is how psychologist Venus Masselam put it. And when your wife is really not in the mood? Some guys abstain. And some guys, in the words of one breast cancer husband, become an "owner-operator."

When a woman is facing a grim, should her husband make the decisions for her?

When the news is bleak, it is all the more important for the patient to be in charge. She shouldn't undergo treatments for the sake of her loved ones. She should do what is right for her, based on the recommendations of her doctors and her own preferences. That's easy to say, hard to carry out. When Carol Shields, the Pulitzer-Prize winning novelist, was facing advanced breast cancer, she tried to live by the rule that the decisions were hers, not her husband's or her family's. But sometimes, she admitted, she underwent an experimental treatment for the sake of the family. And when a woman knows that the end is near, no one has the right to make her feel guilty. Dave Quemere told me how his wife faced her death instead of signing on for one more experimental drug that probably wouldn't have worked for her. Her family thought she was giving up. He thought the decision was the bravest he'd ever seen.

People talk about the new lease on life they feel in the New Normal, when treatment ends. But what about people who liked the Old Normal?

It's true, there are stories about women who make big changes after breast cancer. They quit a job and start a new career, they take up new hobbies, they do things they've always wanted to do. Husbands, too, share the trauma of the disease and they can experience "growth" afterward. But the other truth is that some people really do like the lives they led before cancer came calling, and it's okay to go back to old ways. But there will, no doubt, be some subtle differences. Your wife will no doubt worry about the possibility of recurrence (guys: be empathetic). And then there's the "tumor upgrade"-because although money can't buy happiness, if you can get a few kicks from material things, then, why not. That's why Kathleen McCarthy got new living furniture, and her husband, Colman, got a drum set.