Approaching People with Cancer - 101

Many cultures and traditions emphasize the importance of visiting the sick and being kind to them. Interestingly, it has also been said that people who are sick should be kind to others. I can understand this dictum to a certain extent. It can sometimes feel awkward to approach someone facing a life threatening disease, particularly when that person is an acquaintance and you aren't close enough to be in touch on a regular basis, but aren't distant enough not to be aware of the health issue. Do you ask the person how they are feeling? Or do you avoid the topic altogether in case the person just doesn't want to go there? Plus, if you only heard about the health issue from someone else, are you even supposed to know? If that is the case, should you let on that you know? And if you don't ask about their health, will the person be insulted? Or at the very least, will the health issue become a huge elephant in the room as you discuss the movie you saw over the weekend or the new restaurant that opened up? Do you both even see the elephant, or is it just one of you that sees it? Perhaps the person with the health issue doesn't actually feel sick and isn't thinking about being sick, and at that particular moment, the fact that the person is facing a serious disease is only occupying the mind of the healthy person. On the other hand, perhaps the healthy person has, at that particular point in time, completely forgotten that their acquaintance has a serious disease, and meanwhile the acquaintance may be in a great deal of physical or emotional pain or discomfort and may be quite irritated that their health issue is being completely ignored.

So it is clear that when you approach an acquaintance who is facing a serious health issue, there is a potential minefield of awkward and uncomfortable moments embedded beneath the surface of any discussion that will ensue. Goodness knows that before I ended up with cancer, I was probably as tactless as the next person when it came to approaching someone facing a disease as serious (and fear inducing) as cancer. Since my diagnosis, I have tried to be considerate and understanding when I see people struggle with whether or not to ask me how I am feeling or how to acknowledge the fact that I won the cancer lottery. Occasionally, someone will put their foot so far back into their mouth that they leave me genuinely shocked, but again, I try my best to avoid being overly critical. One of the real gems I received was: "You aren't going to die, are you? Because I really don't have a lot of friends". Then there are the misguided comments from acquaintances who think it is appropriate to mention that their brother's girlfriend's roommate had the same type of cancer as me (they think) and has my skin gotten all yellow and bumpy and crusty yet from the chemo, because that is what happened to that other person.

On the other end of the spectrum, there have been a few considerate superstars who have completely surprised me with their compassion and thoughtfulness. One colleague from work emailed me soon after my diagnosis, but before the word had spread around the office. She noted that I had not been around for a few weeks and wanted to see if I was okay. To be honest, I responded rather curtly that I was fine and would soon be back at work. At that point in time, I was still in a profound state of shock and confusion about my diagnoses, and I was also in quite a bit of pain from various pre-treatment procedures. So I wasn't prepared to discuss the matter with most of my colleagues or acquaintances. However, entirely to her credit, this colleague followed up with an email about a month or two later, when I was far more receptive to overtures from people who wanted to get in touch with me. I ended up getting together with that person for brunch and on a few occasions after that, and each meeting has left me practically giddy from the delightful company and conversation. Our discussion weaved in and out of topics related to my treatment, and we ranged from talking about chemo to where she bought her cute jacket to how many embryos I had frozen to her relationship with her boyfriend. The balance we struck between my disease and other topics was comfortable and effortless.

My journey through cancer, and the way people have treated me and reacted to my diagnosis, has given me insight into how to approach people who are going through cancer treatment. I would like to share some of the things that I have learned:


Get In Touch

First and foremost, do not hesitate to get in touch with the person when you learn about their diagnosis. While it is legitimate to be concerned that the person may wish to keep their privacy, that should not keep you from sending a card or an email along to show your concern. If the person does not wish to respond, then they won't. But chances are that the person will appreciate the note. While this may sound a little cheesy, I recently read a book called "Now That I have Cancer I am Whole" about an ordained minister who had colon cancer, and he said that every time he received a card it was like a prayer was being sent to him. I do not consider myself to be religious, but can truly understand where he is coming from.

What do you write? The answer is that you don't need to say much. A lengthy soliloquy about what horrible news it is and how scary it all must be will not win you points. A short, simple note might go something like this: "I have heard that you are going through a tough time right now. I want you to know that I am thinking about you." You can add a number of other things, as long as they are genuine. If you aren't sure what is appropriate based on your relationship with the person, as long as what you are saying is from the heart, you probably will not go wrong. Some examples of things to say are:

-Ask if there is anything you can do. For example, if you are a colleague, you might offer to check their mail at the office.
-Say "If you would like to talk about it, I am here to listen."
-Ask if you can call them up, drop by, or go out for lunch/coffee.
-Again, as long as you mean it, tell them that you know they are strong and that you feel in your heart they will get through this.
-Say that you miss them or that their presence is missed.

I can also tell you that care packages are fantastic - flowers, chocolates, books and baskets are always welcome. When you have spent the morning puking your brains out and trying to wash your tresses without clogging the drain with clumps of fallen hair, a bouquet of fresh cut flowers delivered to your door can genuinely brighten up your day.

If you have more of a friendly, social relationship with the person facing cancer, then books, magazines and body lotion are also appreciated (skin can get dry during chemo and radiation).


If You Don't Succeed, Try Again

What I have also learned is that, if the person does not respond to your attempt at contacting them, you may wish to try again after some time has passed. People go through several stages of emotions after they find out that they have cancer, and they may become more open to communicating with others after they have had some time to process what has happened to them. I was extremely impressed with my colleague who emailed me a second time after my response to her initial email was less than warm. Initially I wanted to keep my diagnoses very quiet at the office, but that changed over time as I became more educated about what I had and was able to wrap my head around having cancer (as much as that can be done). After about a month or two after my diagnoses, I was much more receptive to hearing from colleagues. However, I would not recommend waiting two months before contacting them for the first time.
It is also important to keep in mind that if the person does not respond after your second attempt at getting in touch with them, then they may genuinely wish to be left alone, and they may not welcome further notes and emails from you.


It Is Never Too Late To Get In Touch

So you have known for quite a while now that a colleague or acquaintance is going through treatment, but have been too uncomfortable to make any contact with them. By the time you work through things and decide that you want to get in touch with them, two months have gone by. While it is preferable not to wait such a long time before contacting the person, it is never really too late to reach out. You may want to tell the person that you have been thinking about them but weren't sure what to say, and that you hope that they will understand.


Check-In

It is also appropriate, and important, to check-in with the person every so often. There are people who just send chocolates and completely ignore the person for the next five months. If you really are concerned about the person, then try to call or send emails every so often to "check in". The emails do not need to be long and drawn out, nor should they be. A simple note asking them how they are doing and letting them know what you have been up to will work just fine. The frequency of these e-mails or calls will depend on your relationship with the person, but I have some colleagues and acquaintances who email me once every two or three weeks, and I have appreciated this. I should note that if your relationship with the person has included getting together with them socially from to time, then you may wish to check-in with them more than you would usually communicate with them. I can say from personal experience that it can be spectacularly isolating to suddenly be labelled "sick", to require treatment that makes you feel sick, and to have to take a leave of absence from work. Your entire daily routine, your social contact with your peers, the sense of validation that comes from working, all suddenly evaporate. Life as you know it is temporarily interrupted and the things that have grounded you are suddenly yanked out from under you. So under these circumstances, calling or emailing every few days - perhaps when things are very rough, even every day or so - can be entirely appropriate and appreciated.

I should also note that this advice applies equally to family members. The extended family of in-laws, for instance, may want to consider checking-in quite often and calling on a regular basis. If you care about this extended family member who has cancer, show this by making a call or visiting them (call first). You need to be in touch with the person more than you normally would, because your care and support will help them through this very difficult time. Sometimes, brief visits are best - the time you spend together does not need to be long and drawn out.


Bring Up The Elephant in The Room

So you are out for coffee or have decided to call a colleague or acquaintance who is going through chemotherapy. What do you say? Do you wait for them to bring up how they are feeling or do you ask? My recommendation is that you should ask them how they are doing. Don't wait for the person to bring it up, because they may actually be waiting for you to see if you are comfortable discussing it. If you have questions about what exactly their disease is or what type of treatment they are receiving, feel free to ask, as long as you are asking because you care and want to understand what they have been experiencing. During the course of my treatment I have appreciated when people have genuinely wanted to get a sense of what I am going through, what the toughest part has been, whether I like my doctors, whether I have met others with the disease or even whether I am part of a support group.
You can start by saying that you have some questions but totally understand if the preferance is not to go into any detail.

What happens if you go out with the person as part of an extended group of friends? Do you start asking questions about how the person is feeling in front of others? Sometimes in these group settings, discussing cancer may not be appropriate. I do think that it is best to discuss how the person is doing when you get together with the person one on one, or with a few close friends.

If you are an acquaintance and just find yourself at the same social function as them, you should proceed cautiously before asking them how they feel. I was at my brother-in-law's wedding and people I barely knew - long lost relatives or friends of friends - came up to me and asked me how I was feeling with a look of exaggerated concern painted on their face. I must admit that I could have done without these comments. The rule of thumb is that if you did not proactively seek to contact the person before the event, and do not intend to check-in with the person thereafter, then you may want to avoid the cancer topic altogether. Let's be honest, you don't really care about them all that much, and they know it. But you shouldn't worry, because chances are they don't care much about you either. We can't all care about everyone, and that is fine. Under these circumstances, any questions you ask will feel more like prying.


The Bottom Line

These are some of my tips and guidelines for approaching colleagues or acquaintances who are going through cancer treatment. Yet you may find these tips equally helpful with respect to people who are going through any number of challenges or hardships in their lives. My own experience with cancer has allowed me to go beyond being able to approach others who are undergoing treatment. Before my journey with cancer, I would not have been comfortable approaching people who were going through a difficult time. Now I know from my own experience and from the responses I have received from others, that asking the person how they are doing and raising the issue that they are facing can be entirely appropriate and appreciated. A family friend in his fifties recently lost both of his parents within a few months, and I asked him how he was dealing with these losses - something I would never have known to do before my own diagnosis. We had a long talk about how he was coping and what he missed about his parents. Based on his response, I think that my willingness to discuss their recent passing was helpful to him.

The bottom line here is that if someone is going through a rough time, you have the power to help them and to brighten their day. All you need to do is reach out and keep in touch.