Forget 50-50

Yesterday I saw a new patient in my clinic, an elderly woman with metastatic breast cancer for several years. In oncology, the only part of the history that interests me more than the HPI is the social history. It is often where I start when I meet the patient, and not only because it's an ice breaker and comforting territory (most patients come to oncologists scared out of their wits). It is there that I learn how educated my patients are and whether they work in science, accounting, or engine repair, which helps me to decide what "level" of explanation of very complicated stuff will best serve them and whether I might be able to draw analogies with things that are familiar to them. It is there that I get some early prediction of compliance and ability to cope with the disease and its treatment: does she have family to bring her to appointments?, does she have someone to go across town to the 24 hour drugstore for her at midnight when she needs more nausea medicine? The social history is my gem.

The patient I saw yesterday had been married for almost 70 years. Wow! You don't see that often. Many people don't even live for 70 years all total. I congratulated them on it and remarked about how wonderful it was, but the conversation quickly turned to their concerns: their kids and grandkids and greatgrandkids (can I still be around them if I am on chemo?) and vacationing in Florida every winter (is is still safe for her to do it?)

At the end of our visit, my last of the day, her husband said, "May I ask you a personal question?" "Sure," I answered. "Are you married?" "Yes, for 8 years, 3 kids 6, 4, and 2." They beamed. Then he said, "So, don't you want to know the secret to staying married for 7 decades?" I thought about that for a moment. Of course I wanted to know. I am in a profession with a high divorce rate. I am married to someone who is active duty military, a group that also has a high divorce rate. I am the child of divorced parents. I hadn't really given it much thought before, but if I had, I might have felt doomed. So suddenly, the social history felt more like a gem than usual. "ABSOLUTELY! PLEASE!" I replied. He said, "Forget 50-50." I must have looked confused because he went on. "Your generation has come closer to equality for women and men than any in the history of our country. And that's a wonderful thing. Only trouble is that now everyone thinks everything, every minute, should be perfectly equal, perfectly divided, 50-50. And the reality is that, in a marriage, it just about never is." His wife had been listening quietly, but then piped up. "It's the truth. When our kids were very young, I was at home with them, and he traveled most weeks Monday through Thursday or Monday through Friday. There were years there where I felt like I was doing 90% of the work of our home and family." He interjected, "You didn't feel like you were doing 90% of the work, honey. You WERE doing 90% of the work." She nodded in agreement. She went on, "Even after he changed jobs and was home more, I still was the one who ran the carpools and worked the bake sales and double-checked the homework. It was 70-30, maybe 60-40 at times, but never 50-50, though we didn't really think or talk in those terms back then." He admitted, "There were times when we thought it wasn't worth going on. Mostly she thought it wasn't worth going on. But we stuck it out." She said, "It's true. There were times when I thought the tables would never turn. But...the last 8 years, Henry has done everything. He cleans our house. He gasses up our cars. He weeds the garden. He shops for the groceries. He makes every single meal. He even buys the cards for all the kids' and grandkids' birthdays and anniversaries and so forth, brings them to me with a pen to sign, and gets them into the mailbox on time. I still remember the day I was told I had metastatic breast cancer almost 9 years ago. I never thought I'd be sitting here having a conversation about it in 2010." Her eyes filled with tears. "We're taking one day at a time," her husband said, clasping her hand in his. "She's long ago beat the odds everyone gave her. And if she keeps it up, we MIGHT actually end up 50-50 after all. And that's the secret."

So, there you have it, folks. Quit counting beans. Forget 50-50, and perhaps you'll find yourself still married 70 years from now. And you might even realize on your 70th anniversary that you are, finally, in fact 50-50.