How to help a friend who has cancer

About a week away from my 30th birthday (I'm still bitter about the timing), I learned I had cancer. The diagnosis came swiftly, after a round, fleshy blob tucked deep behind my right knee finally grew big enough for me to notice, though I'd had mild discomfort there for seven or eight years. The blob, it turned out, was a symptom of my nemesis: synovial cancer, a rare soft-tissue cancer.
Although I was a feisty journalist living halfway across the country, in Toronto, I decided to move home to my parents' house in Edmonton during treatment: four months of chemotherapy, followed by another five of radiation, surgery and recovery. I was scared, self-pitying, pissed off and horribly melancholic. My thoughts vacillated between Am I going to lose my leg? (I didn't, although at one point it was a possibility) and Why the hell couldn't I get the chemo that makes you skinny? (My kind of chemo included appetite stimulants. Plus, my mother's shortbread was an amazing antidote to bone-chilling fear. Note: I did eventually lose the weight I gained.)

A friend (and daughter) in need
But the thought that I liked least, and suppressed more than any other, was, My parents have a daughter who has cancer. Considering that it was a very hard time -- perhaps the hardest of their lives -- for my family, what astonishes me is that they did everything right.

For the most part, they treated me normally. My mom maintained a semblance of routine, even over Christmas, which was four months after the diagnosis. The holiday was what it always was: stuffed stockings in the morning followed by a big breakfast, gift opening, picture taking, and nap time before preparing for supper -- a big turkey spread.

Not everyone did a terrific job of being there for me, but I understand. As Janice Spencer, a clinical social worker in the Cancer Care program at Queen Elizabeth II Health Sciences Centre in Halifax, says, someone without cancer can't possibly fully "get" what it's like for the person who has it. That makes it hard to know the right thing to do or say, and obviously, the "right" thing differs from person to person. Still, I'd like to offer my own answers, and some suggestions from experts in the field, to questions you might have if a friend or family member has been diagnosed with cancer.

It's better to say the wrong thing than to say nothing at all
A lot of people I know said the wrong thing at one time or another. A sampling: "If I lose someone else in my life I don't know what I'll do"; "That hat's not very flattering" (I chose not to wear a wig); and "I finally figured out why you look so different -- you don't have any eyelashes." True, these comments were insensitive and smarted a bit. But no one ever said anything that diminished my experience, which can be demoralizing for a cancer patient, says Nicole Couillard, a teacher based in Cochrane, Alta., who also works as a youth- and family-support programmer, specializing in therapeutic and recreational oncology programs for families.

Click to continue...

Page 1 of 4

You might be tempted to say, "I know how you feel." Or, "You'll get through this." Or, "When my friend went through breast cancer...." Though well intended, comments like these imply a mutual understanding that just doesn't exist -- even between doctors and patients -- when it comes to battling the highly individual war against such a seemingly universal disease.

Acknowledge the elephant in the room
That being said, I'd rather have someone risk saying the wrong thing than nothing at all. One of my closest friends rarely called, and when we did chat, she trod lightly around my situation. I understood why: she'd lost her mother to cancer a few years earlier. But her avoidance came across as coldness, and I felt very alone when I got off the phone with her.
Some people are so uncomfortable that they avoid the elephant in the room, says Spencer. But, she says, this reaction is often the worst because avoidance can be perceived as abandonment. My recommendation: Don't ignore the cancer in a conversation. Even, "I wish I knew how to make it all go away" goes a long way. As Spencer says, "Most people need to know that their supports are there, that you are there, that you understand they are the same person, and that they are not their disease."

Trust your instincts
Starting every conversation with "How are you?" takes on a whole new meaning when the cancer victim is raging against fate, day in, day out. The key to making conversation is to not try so hard. The cancer is there and -- believe me -- it will come up sooner or later. "The best thing is to trust yourself and use your instinct as a guide," says Couillard. "And don't make the conversation about you."

Sometimes, people personalize the patient's experience by talking about how it is affecting their lives (for example, "I was so worried about your test today, I didn't get a good night's sleep last night"). But this just adds to the patient's burden, because now she has to worry about how she is affecting you.

Instead, says Couillard, "just be present in the conversation and validate whatever the person with cancer is sharing with ‘yes' and ‘is that right' and ‘tell me more.'" Spencer adds another important tip: maintain hope, and point out areas where you observe strength. My inner strength was buoyed greatly by anyone pointing out how well I was coping.

Click to continue...

Page 2 of 4

Normalcy can be comforting
Some of my chemo regimens required me to be in the hospital attached to an IV for three- and five-day stints (probably the hardest part of my whole experience was having no control in that desperate, sterile environment). My mom showed up every day, like clockwork. I would wake up and she would be sitting beside me, reading a book or patiently waiting. She'd recount whatever had happened the night before, what she'd cooked for dinner, who'd called, etc. I found great comfort in the normalcy of the conversation. She was just herself, being herself, and I was just me. The circumstances faded to the background. 

On the flip side, a very dear, old friend would sweep into the room in a flurry and without notice, sometimes with someone I hadn't seen in years (not a good idea). At the beginning of my chemo she insisted, "You really need to get your head shaved before your hair all falls out," and said that she would be happy to organize the dirty deed for me. Now, ask anyone who knows me: my long, brown tresses are like an appendage. Thinking about losing them, and how, was trauma enough without actually pre-empting the event. (Which turned out to be four days after my first round of chemo, in a hospital at 4 a.m. -- large chunks gave way with the slightest tug. The nurse who agreed to shave my head, which I now realize was probably a first for her, put on such a confident and positive front, I could imagine exactly what it would be like to have a sister).

Understand that everyone deals with cancer differently
Another time, my friend bought me a plastic blow-up thingy to use as a punching bag. But it was so out of character for me, I couldn't even imagine inflating the stupid thing, never mind hitting it. Finally, she crossed the line when she shared some of my extremely personal -- and embarrassing -- health information with a bigmouthed health-care specialist we both knew in an effort to help find me a remedy. I was angry. I felt my privacy had been violated (trust me -- any patient spending time in hospital considers dignity precious). When I told her that upset me, tempers flared and she hung up on me. I left a message telling her not to call me, that I would call her.

The problem, I realized, was that while my friend really wanted to be helpful, she never asked me what I needed or wanted from her. And since you can't guess what the right thing to do is, says Spencer, "just ask. Say, ‘I'd like to do this, what do you think?' not ‘I'm going to do this.'" I certainly didn't always know what I needed, but it would have been nice to choose, or be given the opportunity to say, "No, thank you."

Click to continue...

Page 3 of 4

Be open to discussion and ask questions
Again, I recommend asking what the person with cancer wants. I had a wonderful Christmas thanks to my family, who asked me what I wanted beforehand. In fact, my mom made it even simpler for me by asking if there was anything I didn't want to do. Other than limiting visits with my nieces and nephew because of my low immunity, we went ahead with the festivities, including going out to a fancy French restaurant for New Year's Eve.

In retrospect, I am amazed at how the heartbreaking circumstances did not once supersede the much-loved routine of hanging Christmas decorations or opening presents. In a way, Christmas allowed us to experience something good together in spite of our fears. We were grateful for the opportunity to push them aside. (And I suggest avoiding cancer-related cards or gifts. Suggesting I "stay strong" or reminding me that this Christmas was different would have provoked a tear fest. But that's just me.)
Spencer told me how the family of one of her clients with cancer, a woman who normally hosted Christmas dinner, arbitrarily took the responsibility off her plate. "Although they thought it would be helpful, it was just a reminder that something was different. It felt to her that this is what they might do after she dies. She cherished cooking the meal at her own home; it was part of her identity. And people want to hold on to who they are when they are especially scared."

Deal with your own feelings, too
Once, I'd been visiting a friend, and was just out the door, when she started to break down. The cancer-free me would never have left her like that, but I gave a quick, far too firm, "It's going to be OK," barely breaking stride down the front porch. Although I still haven't forgiven myself, at the time I just couldn't face her fear.

According to Spencer, everyone experiences a loved one's cancer in his or her own way. And while it's important to address your feelings, you shouldn't hinder the person from experiencing cancer in any way. That's why she advises friends of people with cancer to seek counselling. Couillard suggests you rally your own support network. Seek out caregiver programs at hospitals and organizations such as Wellspring.

My mom and dad supported each other incredibly well, and are two of the bravest people I know. That I got through those nine months and the long road to recovery with my spirit intact is thanks to my family. As for those who helped -- or tried to -- I like to think that our mistakes might offer some guidance. And that, I think, is my way of acknowledging that even when their efforts weren't what I needed, I am grateful for their good intentions.

Never underestimate the healing power of female friendships, especially when one of your buds needs a shoulder to lean on.

Page 4 of 4

This article was first printed in the December-January 2009 issue of Homemakers Magazine. Click to subscribe online and never miss an issue.