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and self-expectations for men to be strong, self-sufficient, and protectors of their homes from public institutions and affairs outside. As protectors, men ensured that women were receiving the proper care, often approaching health care providers to question their actions. Melanie, the nurse stated:

Men definitely are the protectors and if they think something isn’t right, they will get more involved, because they want to protect that spouse and they want everything… that can be done, to be done (Melanie, nurse).

Helen, the nurse, stated that she received several complaints from a male caregiver who interrogated her in relation to his wife’s experiences in navigating the health care system:

Jeff …says, ‘How come she had to wait so long when you called the doctor? Why couldn't you make it happen faster?’ …. He was blaming it on me. There's always a complaint at each visit (Helen, nurse).

Cultural expectations to be strong and self-sufficient also meant that men assumed responsibility to make significant household decisions, as one male caregiver related:

It gets to the point where you get kind of down and if I show weakness around my wife, she gets weepy….Sometimes I don't agree with what [my wife] says and then I tell her, and she agrees with me…. Well, that's just me. It's just the way I was brought up. I'm a decision-maker…(Jeff, caregiver).

The responsibility of being protectors and decision-makers tended to preoccupy men and may have drawn them away from important and sensitive matters in hospice palliative home care, such as the discussion of existential issues (e.g., dealing with death) with wives and nurses. Overall, assuming the responsibility of protector was stress-producing for men, as they at times angrily lashed out at health care providers. However, under

expectations of appearing strong, men may have concealed their stress, perhaps causing even more mental strain.

Indeed, female clients and caregivers, and nurses, expected that male clients downplay their symptoms in an effort to appear strong. Women expected that men would push themselves beyond their capabilities and underrate their pain and symptoms, despite physical limitations because of illness. As one nurse stated:

A lot of the men, even though they really can’t do something, will push

themselves and push themselves... “I can do it, I am a man, I am strong, I can still do this”…. I find a lot of times with the men, they under-medicate and underrate their pain…..A lot of times the wife will be the one wanting to answer it or the husband will say, “My pain’s a two” and the wife will say, “Oh no, you told me this morning you could hardly stand it.” So a lot of the information we get is from the wife, because a lot of men…don’t want people to think they’re sick. (Melanie, nurse).

Nurses and female caregivers may have been more liberal in giving pain treatment to men. Furthermore, cultural expectations to be strong were perpetuated as women expected that men would attempt to meet masculine norms. Rather than take a patient- centred approach to care, nurses instead tended to shape their practices around gendered expectations. Men ultimately were disadvantaged as reports of their own health may have been misinterpreted.

As men attempted to fulfil gendered expectations of independence and self-

sufficiency, they were particularly distressed when their driver’s licenses were revoked

because of medical conditions or medication side-effects. As one wife described:

Stan’s independence has been taken away from him, which is very hard for him – the lack of driving. And me driving, and me taking over,…that has even been more demeaning for him. It’s made it tougher for him (Laura).

One nurse advised Laura, a female caregiver, that male clients feel devastation when they are unable to drive. Stan frequently related his distress over his inability to drive and

admitted to driving in the neighbourhood without a license to maintain his driving skills. Melanie, the nurse, recalled several instances in which men’s dependence on others

caused distress:

[Men] are so independent, and they don’t like to ask people for help. And any of the patients who are men, and lose their [driver’s] licence, they’re very upset. They feel bad about how they have to depend on their wife or some other family member to drive them around, and that’s a big concern (Melanie, nurse). One client reported that he had stopped taking his pain medications in an attempt to reclaim his license to drive. Thus, the expectation to be self-sufficient was illustrated by participants’ attention to male clients’ needs to maintain their driver’s license and remain

independent. Because of expectations for men to be strong and independent, male clients became emotionally distressed. Nurses and caregivers reinforced these expectations by acknowledging them. Ultimately, men were simultaneously advantaged and

disadvantaged because of these gendered expectations.

3.4.5 Gendered exemptions for men. Men were generally exempted from care