Virginia Ironside: Dilemmas

Dear Virginia, My husband has discovered a swelling on one of his balls (sorry to be so frank). But the thing is that he refuses to go to the doctor, though I have begged him and pleaded with him. Then last night he suddenly burst into tears – which is very unlike him – and said that if it turned out to be cancer, he'd probably kill himself, and that's the reason he doesn't want to have it investigated. I'm frightened, furious and miserable. How can I persuade him that he must see a doctor? I've told him that if he catches it quickly there's a much greater chance it can be cured, but he won't listen. Yours sincerely, Betty

Whenever anyone deeply unhappy mentions suicide I am, of course, immediately sympathetic. However, when they start bandying the idea around as in "If you don't do this I'll kill myself", or "If you leave me I'll bump myself off" or, even, like Betty's husband, "If I find out I have cancer I'll end it all" I get rather tetchy. Sympathy goes out of the window. There's too much emotional blackmail around. It's below the belt. Were I Betty, I'd be tempted to riposte "Well, if you don't see the doctor I'm going to hurl myself over a cliff!" and see how her husband liked the boot being on the other foot.

But that would be a childish tit-for-tat which isn't going to get anyone anywhere. Let's hope that what her husband is really trying to say is that at the moment he finds the thought of having cancer almost unbearable, so unbearable, indeed, that he's prepared to risk dying of cancer rather than face the facts.

I would tell him that you, too, find the idea of him not seeing the doctor intolerable. That in this case you are not two individuals, but a couple, and what affects one affects the other. It is not fair of him to be so selfish. If he still persists, then would he listen if you suggested he saw the doctor about his cancer phobia rather than to have a test? He could surely find nothing scary about that. He could go to the doctor, describe his symptoms, emphasise that he has absolutely no desire to know whether it's cancer or not, but to say that his reaction to all this has been so over-the-top that he's worried that he might not have some kind of phobia. Could this be treated first?

Of course all this, as you and I know, is just a wheeze to get him to see the doctor. Once in the consulting room I have no doubt the doctor would be able to reassure him that it is quite possible the lump is benign, and that early treatment could well be successful, and so on. I'm afraid, like everyone, your husband is far more likely to listen to a doctor saying all this than you.

If he refuses, then I'd make an appointment to see the doctor yourself. He might be able to inveigle your husband in for a general health check. Or he might at least be able to give you information about what tests would actually have to be done – and lots of scary stuff about the risks of leaving it to chance, which you could relay back home. Or find a friend who's had the treatment and is now as fit as a fiddle. Whatever, don't despair or give up. It's too important.

It's a cry for help

Betty does not mention her husband's age, but the greatest risk period for testicular malignancy is in the teens and twenties – though any age can be affected. Most lumps in the scrotum are not malignant, though that is what everyone fears. Ideally all lumps should be investigated immediately and if it is a malignancy then the sooner the definitive treatment is provided the greater the chance of benefit.

Fear is obviously the wrong word to describe Betty's husband's state of mind. Scared shitless is probably a bit closer. Then there's the fear of what would be done to him in pursuit of a diagnosis or treatment – thoughts of clumsy examination by a gimlet-eyed clueless female doctor with a grip like a vice and needles and things shoved up where they ought not to be etc.

The truth, of course, is nothing like that. Physical examination by a doctor of the man's choice should involve the gentlest touch. Rectal examination might be offered but can be declined. Ultrasound examination involves the lightest of touches and is all on the skin surface. Nothing nasty happens at all.

When the chips are down, the risk of self harm is not zero. The manner in which Betty describes her husband's reaction suggests to me a cry for help. Can siblings, parents, older children, relatives, friends or work colleagues be helpful? Do you know anyone who has been through something similar? Do you have any medical friends who could have an informal but more authoritative word? Any decent bloke would offer to accompany your husband to appointments and you should ask if he wants you there.

If, despite everything, it is still no go, then I would tell your husband that you are going to inform his GP and then do so, including your own assessment of his risk of self-harm. The absolute bottom line is that investigation and treatment cannot be compelled and, unless your husband develops overt psychiatric symptoms requiring section under the Mental Health Act, you will have done all that you possibly can and no blame attaches to you whatsoever – not that that would be much consolation.

Steve Ford

By email

Let it sink in

You have told him the advantages of seeking treatment with early detection, which prompted his emotional outburst. This is a step in the right direction. The next step is to show him that he could be causing himself more pain by avoiding the doctor and avoiding receiving a diagnosis his refusal to go may just be initial shock and his assumption that he won't be able to handle bad news. Once he has had time to reflect he will probably seek a doctor's opinion.l

Moya Mcdermott

By email

See the GP yourself

You have clearly done everything you can to try to persuade your husband to see his doctor. The only option left is for you to make an appointment to see your doctor yourself. Explain the problem and ask for his/her advice. He/she will know what to do as your husband's reaction will be quite common.

Malcolm Howard

By email

Next week's dilemma

Dear Virginia, I'm about to book a last-minute holiday for my family. My dilemma is that if we take a flight that gets us back three days after the beginning of the school term, the cost will work out to be two hundred pounds cheaper overall. The school is rather iffy about this kind of thing, I've heard, and they regularly remind parents not to take holidays during term time. But I don't think a few days out of school matters, do you? Lots of other people in my six-year-old daughter's class are doing the same, I gather. I'm torn between spending such a large amount of money and getting my daughter to school on the first day or saving money and getting her back late. Surely it won't make any real difference to her education? Yours sincerely, Jen

What would you advise Jen to do? Email your dilemmas and comments to dilemmas @independent.co.uk, or go to www.independent.co.uk/dilemmas. Anyone whose advice is quoted will receive a £25 voucher from the wine website Fine Wine Sellers (www.finewinesellers.co.uk)