What to say to someone who has cancer

After worrying for the better part of a week which obscure sport needed its rules explained for my writing class (final paper topic #17), I realized I should focus on something I actually care about. So I wrote a speech about how to talk to and support someone with cancer (final paper topic #19). Here we go. But just so you know, I think the first page of the Camel Wrestling paper was awesome.

Other people have great ideas and tips on this topic (cancer support, not camel wrestling). Previous posts:
          Avoiding the Stupid Comments List (3/14/13)
          How not to say the wrong thing (4/9/13)

I hope this can help someone who reads it as much as it helped me to write it.

Go Team Liz.

Cancer Needs a Hug

     When I was four years old my family went camping in the Colorado mountains. My dad took a photo when my seasonal allergies where at their worst. No tissues were available—and who has time for Kleenex when gallivanting in the woods—so I used the next best thing: my unwashed, muddy, sappy right hand. Filthy face and an especially black smeared nose. My ironic pale yellow shirt read hug me.

     My wife, Liz, has advanced stage breast cancer. Like the mountain muck on my childhood face, you can see the worries and pain and frustrations on hers. She is missing her hair, eyelashes, and fingernails. All outward appearances emphasize the exhaustion and discomfort caused by chemotherapy. She is one of many in the United States who are feeling the effects of this disease: nearly 300,000 women are diagnosed with breast cancer each year, and another 40,000 women die from it.

     When someone is diagnosed with cancer, most people don’t know what to say to the patient: they instinctively respond to the grime they see and neglect giving the hug that she needs. Saying the right thing, or avoiding the wrong one, may be more difficult if this is the first time they have encountered someone with cancer. What seem like natural or helpful questions and comments may actually be hurtful. Here are some of the best ways to engage a friend or family member in crisis, based on what we have experienced.

     First, say something. You may be uncomfortable facing the realities of cancer, but the patient needs to know that you are still there for her. If you don’t know what to say, start with that: I just don’t know what to say or how to say it, but it is terrible that you have cancer, and I am here for you. Sometimes the most helpful things are questions: Is this a good time for you to talk? Do you want to talk about it? What is weighing on your mind today?

     You might not want to bother her, or you might not know how to start the conversation. But feeling abandoned by friends can be worse than any imperfect comment. Pick up the phone, send an email, or stop by. It means more than anything. Try not to ask if it is terminal, how long she has, if chemo is hard, if it is one of the bad kinds of cancer. Remember that the patient is constantly thinking about the what-ifs, and she thinks about her own frailty each day. She needs you to speak up and be a friend, more now than ever.

     Second, show support. Contrary to what you might think, overused cheery statements are neither helpful nor supportive (it will all work out, you will be fine, keep your chin up, hang in there). These imply that a positive attitude will overcome any physical challenges. Likewise, lamenting on how bad things are (this is so unfair) only serves to bring her into a deeper funk. Cancer ain’t a barrel of laughs. And the patient might not actually get better. So find a way to be there for her and listen.

     She does not always want to hear that she is brave, she is a fighter, she is strong. She is brave simply because she is sick? So what was she before cancer? And what is the alternative to trying to fight? Be careful not to place more emotional burdens on her than she already bears.

     Asking what you can do to help is not enough. Let me know if you need anything is an invitation to never receive a call back. Be specific and direct: I am bringing dinner tomorrow night, what will you eat? Can I take your kids to the zoo this afternoon? I’m on my way to your house to do your laundry. I’ve been watching you. (Never mind that last one, that was creepy.) She already feels guilty for not being there for everyone else, especially since she has so little control over this aspect of her life. Do her a favor and allow her not to worry about some things for a while.

     Third, acknowledge that the patient’s situation is unique. It is natural to seek common ground, to share life experiences and talk about what you have learned through others. But do not tell her about someone you know who experienced something similar. If that person is fine, then the patient will wonder what his situation has to do with hers (hint: nothing). If he died, she does not want to hear about it anyway.

     Instead of saying I know how you feel, try this: I imagine this is difficult for you, I don’t presume to know how you feel, and I know everyone’s experiences are different. Do not talk about Lance Armstrong, other famous survivors, or talk about all of the people who “beat it.” And never, ever talk about anyone who died: You have breast cancer? My 84-year old aunt had throat cancer. She really hung in there until she passed away. Doh.

     Fourth, be sincere. A quick you look great can either be good or bad, depending on your relationship with the patient and how earnest you are. She knows if she does not look good. But if she is feeling unusually great, a well-placed comment can help lift her spirits. Or if she looks tired and ill, focus on something you can sincerely complement: her eyes, her smile, her hair, the grace with which she deals with her challenges.

     Chemotherapy cycles come and go. When a cycle ends, the patient will be glad to be “done” but knows that the rest of her life will include tests and scans and treatments to keep the cancer at bay. There is not really a light at the end of the tunnel, and congratulations are not really in order. All she wants is to feel well, to be there for her family, to enjoy life. But she will need you if the cancer returns. So celebrate the wins, but do not assume that her cancer fighting journey is over. She needs your ongoing friendship and support, especially when things get tough again.

     Finally, do not offer unsolicited advice. This one is hard, particularly when you are sure there is something that the patient has not considered, learned, or tried. Especially when she is first diagnosed, keep your advice to yourself, no matter how important you think it is. Mentioning that God has a plan for you or that God doesn’t give us more than we can handle just makes her feel worse for wishing things were different or that her road were easier.

     If you feel compelled to share your opinion, wait a day. Then if you still feel compelled, wait another. Still feel the same? Take a deep breath and first ask the patient if she would like to hear about the study, the article, the medication, the natural therapy, or the book. She might say no, and that’s okay: she needs you to support her decisions, even if you disagree with them. She is in charge, not you. She also needs to trust her treatment and her doctors, so any comments that make her question her doctors can cause more confusion and frustration when she really wants less.

     That was a lot of unsolicited advice. But it was free, and you get what you pay for. Just remember that the patient wants to have normal conversations, have friends she can count on, have time to laugh and enjoy life. When you have something to say, first ask yourself if it will help strengthen, support, and uplift her. If not, share it with someone else. Be there for her. Because no matter how messy things get, she will always need a hug.