Re: Where to begin
If this has been going on for 18 years, it's unlikely he will change. I was with my ex the same number of years and in my 30's when I finally decided to leave. He married 2 months after we divorced and found someone new to take care of him. His lack of empathy with your test results is also something I had dealt with (he did a no show when a test result came out bad when I was pregnant and he was supposed to meet me at the Dr's office & invited a buddy over to drink beer the night of my mother's funeral & couldn't understand why I wasn't in the mood to hang out with them) If you decide to tell him you are done, he will most likely fear being on his own (assuming he has no where to go) and either shape up temporarily until things get better again or shape up for good.
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