What Friends Are Not For

In the past two weeks, I have had at least four calls from patients who have had a well-meaning friend tell them the most insensitive things related to their new diagnosis of breast cancer. I could not believe what I was hearing until the following thoughts occurred to me.

• Some people feel so awkward around the newly diagnosed woman that they just don't know what to say, so comments come out in unintentional ways.
• Some will feel sad for their friend or loved one, but also fortunate and relieved in some way that it is not them. They are confronted with the possibility of death, and they are afraid. It brings up so many of their own fears.
• Some just feel that, if they read something on the Internet or have a family member go through the same thing, this makes them an expert in breast cancer treatment. They feel it necessary to pass along their knowledge
• Telling the woman that she is lucky, that she is married and her husband doesn't care about her breasts, or that she chose the wrong doctor for the surgery is counterproductive.

Lori Hope knows this from both sides of the sickbed. She oversaw the care for a close friend with cervical cancer and helped care for two cousins with breast cancer. She herself is a five-year survivor of lung cancer -- an experience that led her to write a book for all of us foot-in-mouth well wishers, Help Me Live: 20 Things People With Cancer Want You to Know, which Celestial Arts published in 2005.

Here are a few excerpts from her book:

• Be prepared to talk about things that will be of interest to that person, which will not dash their hopes. Most people with cancer don't want to hear about the latest terrorist threat. So think about some light things. Think about what the other person enjoys. We get so caught up in our own fears that we forget to think about the other person. It's not about you...
• It's important to support your friend's treatment decision. So if someone decides not to opt for a mastectomy, it's not helpful to raise objections. The same if she's decided to have a prophylactic mastectomy because her mother and grandmother died of breast cancer. People arrive at these decisions after long and deep thought. And it doesn't matter what you would do in the same situation...
• Most of the important things are more about being than doing: be there, be generous. Say that you just want them to know that you are there for them and that you really love them. It is ok to say that the diagnosis is so unfair...
• Maintaining eye contact is essential. When you are really listening, patients can see it in your eyes. Touch a hand, if the person is a touchy person. Asking if you can give them a hug -- asking is particularly important after surgery as the person may still be having pain...
• Being quiet. That is such a great gift, especially if someone is really ill or just post-surgery and they don't have the energy for a conversation. It's very hard for most of us to be good listeners.

I have spoken to my many patients about "friendly" comments. I tell them to be strong enough to let their needs be known. Change the subject to areas you are ready to discuss, and set the agenda. No one will be perfect in this situation.