Sunday, April 14, 2013

For a Sick Friend: First Do No Harm

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I saw this article in the April 13 edition of the WSJ.  It's not something I really wanted to ponder on a beautiful spring day, but ponder I did.  The article discusses how we should act and treat our friends or family members who have critical or terminal illnesses.  The reason I'm pondering this is because I am a woman of a certain age.  Meaning that the majority of the people around me are also of a certain age and are now more prone to critical or terminal illnesses (like breast or prostate or colon cancers).  Yuck :((  So, here's a primer by Letty Cottin Pogrebin from her book "How to Be a Friend to a Friend Who's Sick".  Conversing with the ill can be awkward, but keeping a few simple commandments makes a huge difference: A young doctor nurse visiting an elderly sick woman... Read more...

Rejoice at their good news.  Don't minimize their bad news.  A guy tells you that the doctors got it all, say, "Hallelujah!"  A man with advanced bladder cancer says that he's taking his kids to Disney next summer, don't bite your lip and mutter,  "We'll see."  Tell him it's a great idea. (What harm can it do?) Which doesn't mean that you should slap a happy face on a friend's grim diagnosis by saying something like, "Don't worry!  Nowadays breast cancer is like having a cold!"  The best response in any encounter with a sick friend is to say, "Tell me what I can do to make things easier for you-I really want to help."

Treat your sick friends as you always did-but never forget their changed circumstances.  However contradictory that may sound, I promise you can learn to live with the paradox if you keep your friend's illness and its constraints in mind but don't treat them as if their illness is who they are.  Speak to them as you always did (tease them, kid around, get mad at them) but indulge their occasional blue moods and hissy fits.  Most important, start conversations about other things (sports, movies, food, politics) as soon as possible and you'll help speed their journey from the morass of the illness to the miracle of the ordinary.

Avoid self-referential comments.  A friend with a hacking cough doesn't need to hear, "You think that's bad? I had double pneumonia."  Don't tell someone with brain cancer that you know how painful it must be because you get migraines.  Don't complain about your collicky baby to the mother of a child with spina bifida.  I'm not saying sick people have lost their capacity to empathize with others, just that solipsism is unhelpful and rude.  The truest thing you can say to a sick or suffering friend is, "I can only try to imagine what you're going through."

Don't assume, verify.  Several friends of Michele, a Canadian writer, reacted to her cancer diagnosis with, "Well, at least you caught it early, so you'll be alright!"  In fact, she did not catch it early, and never said or hinted otherwise.  So, when someone said, "You caught it early"," she thought, "No, I didn't, therefore, I'm going to die."  Repeat after me: "Assume nothing."

Get the facts straight before you open your mouth.  Did your friend have a heart or liver transplant?  Chemo or radiation? Don't just ask, "How are you?"  Ask questions specific to your friend's health.  "How's your rotor cuff these days?" "Did the blood test show Lyme disease?" "Are your new meds working?" If you need help remembering who has shingles and who has lupus, enter a health note under the person's name in your contacts list or stick a Post it note by the phone and update the information as needed.

Help your sick friend feel useful.  Zero in on one of their skills and lead to it.  Assuming they're up to it, ask a cybersmart patient to set up a Web page for you; ask a bridge or chess player to give you pointers on the game; ask a retired teacher to guide your teenager through their college application process.  In most cases, your request won't be seen as an imposition but as a vote of confidence in your friend's talent and worth.

Don't infantilize the patient.  Never speak to a grown up the way you would talk to a child.  Objectionable sentences include, "How are we today, dearie?" "That's a good boy." "I bet you could swallow a teensy pill if you really tried."  And the most wince worthy, "Are we ready to go wee wee?"  Protect your friend's dignity at all cost.

Think twice before giving advice.  Don't forward medical alerts, newspaper clippings or your Aunt Sadie's cure for gout.  Your idea of  a health bulletin that's useful or revelatory may mislead, upset, confuse or agitate your friend.  Sick people have doctors to tell them what to do.  Your job is simply to be their friend.

Let patients who are terminally ill set the conversational agenda.  If they're unaware that they're dying, don't be the one to tell them.  If they know they're at the end of life and want to talk about it, don't contradict or interrupt them; let them vent or weep or curse the Fates.  Hand them a tissue and cry with them.  If they want to confide their last wish, or trust you with a long kept secret, thank them for the honor and listen hard.  Someday you'll want to remember every word they say.

Don't pressure them to practice positive thinking.  The implication is that they caused their illness in the first place by negative thinking-by feeling discouraged, depressed or not having the "right attitude".  Positive thinking can't cure Huntington's disease, ALS or inoperable brain cancer.  Telling a terminal patient to keep up the fight isn't just futile, it's cruel.  Insisting that they see the glass half full may deny them the truth of what they know and the chance to tie up loose ends while there's still time.  As one hospice  patient put it, "All I want from my friends right now is the freedom to sulk and say goodbye."

Hopefully these ten commandments should help you relate to your sick friends with greater empathy, warmth and grace.

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