Why, Why, Why

Struggling to understand cancer's random cruelty

“Why do bad things happen to good people? We ask that question so often, it’s become a cliché. But that’s because bad things do happen to good people. Constantly. You just have to hope that, when it’s your turn, you’ll know what to do. How to cope. How to persevere. But the truth is you don’t know how you will react to your worst-case scenario. None of us do. Not until it happens.” – Grey’s Anatomy, Season 11, Episode 20.

Why him? my mind screamed. How can we live in a world that is so cruel to take this good man, good father, and good husband away? Doesn’t the universe know how much we need him? Our girls are in middle school with rapidly changing minds and bodies. They need him. I need him. Our family doesn’t function without him. The thought of losing him before our daughters finished high school was unimaginable.

My husband is a very nice guy, a caring husband, and devoted father. He loves his family and does his best to support his mother, sisters, and friends. The dog loves him the most of everyone in the family. I can always count on him to do the right thing, even when it’s hard. His family comes first, and he is a great parent. And he takes excellent care of his body, eats well, and exercises.

He is the kind of guy who finds time to exercise almost every day, eats green vegetables with lunch and dinner, and prioritizes his sleep and nutrition. He is the kind of guy that has tried and excelled at more than a handful of sports, even continuing to play squash competitively for 10 years after his college squash career. He is the kind of guy that intentionally prioritizes his health in many ways and exercises his willpower once a day to resist unhealthy temptations.

He is the L-A-S-T person that I could imagine might get a diagnosis of advanced breast cancer at his age. Doesn’t his lifetime of healthy living, sports, and clean eating count? Is there any justice in the world?

As a physician, I have seen terrible things happen to the nicest people over and over again. It began during my medical school and intern rotations though emergency rooms when I began to encounter families experiencing sudden and tragic loss. Car and bike accidents, heart attacks, suicides, overdoses, strokes, and random acts of violence happened out of the blue to the nicest people.

As a medical student, I remember meeting with a young couple while I was on my neurology rotation. They had come to the Mayo Clinic from a neighboring Midwest State in hopes of finding an answer for a bad diagnosis.

The mood in the clinic room was understandably somber. I tried to be both serious and upbeat to bring hope to the situation. I would take their story and summarize it for the attending neurologist. We would both return and then he would give his opinion and what could be done.

The young man’s symptoms started on their honeymoon. He woke up with a splitting headache that made it hard for him to get out of bed. The headache kept coming back and was typically worse in the morning and when he coughed.

Within a week, he noticed that his vision was a little blurry. This got worse and worse until he began to have double vision. It was hard for him to keep his eyes open at this point, so he kept them closed during parts of the interview.

They cut their honeymoon short to take him to his doctor. The brain scan showed a tumor that was in a place that would make it tough to remove. They had come to the Mayo Clinic full of hope.

I began asking a series of questions that would help the neurologist to pinpoint the extent that the brain tumor might have spread. Did he have difficulty swallowing, speaking or facial weakness or numbness? Had he or she noticed any changes in his voice or speech? Any nausea or vomiting? Had he noticed any difficulty walking?

He answered my questions in a measured and even tone, but the young wife said nothing. She sat next to him, squeezing his hand, staring down at her lap or at him. Although I was focused on him, she never made eye contact with me.

At the time, I didn’t really think about the wife. She wasn’t the patient. Her grief and internal turmoil weren’t my immediate concerns. I should have asked more about her experience. Why didn’t I reserve a few questions about how she was doing?

Ironically, I understand her so much better twenty years later. At least, I think I do. Projecting backward, I think she was feeling something like a mix of terror and shock. Weeks before, she had married her great love and had the start of a plan for a life together. Maybe they were saving up for a down payment on a house. Perhaps they had been trying to start a family on their honeymoon. She might have even been pregnant at the time for all that I knew. Her world was turning upside down.

The young wife didn’t make eye contact with me during that clinic visit because she couldn’t. Something terrible had happened to the love of her life. Processing how and why this happened with a shocked, grief-stricken brain was an excruciating experience.

I left the patient’s room to find the neurologist so that we could discuss the case privately before returning to talk with the young man and his wife. I quickly presented his case, the evolution of his symptoms and the report summary from the brain scans. The neurologist and I reviewed the brain scans, and he showed me the location of the tumor and why it would be so dangerous to remove.

“The tumor is located in the base of his skull, and it is very unlikely that we can remove all of it,” he said while studying the images with furrowed brow.

My stomach fell as I thought of the young man and his wife waiting and hoping for good news. Their hopes were pinned to this visit and in a few moments, they would be given bad news.

We returned to the patient’s room to find both young faces lighting up in anticipation. The neurologist introduced himself and sat down to discuss his opinion of their case. Within 30 seconds, that brightness would dim as the somber voice of the neurologist began to lay out the challenging location of the tumor and the uncertainty and risks of the surgery. Even if surgery was performed, the tumor would likely come back.

Her eyes clouded over as she listened. Only now could I understand a small piece of what the young woman was going through. Within two months, she had experienced the high of her wedding day followed within a few weeks of an unfolding nightmare likely to put her in the role of being a caregiver for many years while her young husband deteriorated.

So sad for this couple, I thought. But subconsciously, I finished the thought by distancing myself from the situation. Medical tragedies like this one happen to other people. But not to me or my family.

But this was far from the truth. Tragedies do happen to very good people. Why did an unbelievably rare cancer afflict my healthy husband? There is no answer. But this injustice had happened to other people and now it was happening to him, me and our girls.

I didn’t know if I could ever accept it.