how to help a friend when she learns she may have terminal cancer

December 31, 2011 5:08 PM

My friend is about to get get some very serious news regarding her health which carries with it a very, very poor prognosis and I am looking for advice on how to help her when she gets this news.

This friend, while in the hospital, was recently diagnosed with a particularly bad type of cancer. Other than the initial visit with the oncologist who gave her the diagnosis in the hospital she has yet to go in for another consult (due to the holidays and the oncologist being out of office). However I work with her primary care doctor and, with my friend's permission, I have spoken to her about the results of the tests they ran in the hospital. Things look very grim. Her primary care doctor told her this news as well but I don't think my friend understands, at least not that she is expressing to me when we have discussed it, what a poor prognosis this type of cancer carries.

Important to note here is that my friend is not looking to me for medical advice, although I do work in a context which makes me more knowledgable about medical issues than the average person. She has not asked me to explain these diagnostic tests and their results to her, although she asked me to accompany her to her oncologist appointment next week because she wants someone there who knows what questions to ask and speaks the language, so to speak.

I am nearly certain she is going to hear from her oncologist, at best, that her cancer is at an advanced stage or, at worse, that it is terminal. I fear it is the latter and not the former. I would be lying if I said that I wasn't experiencing some anxiety over being there with her when she receives this news as I have never before been in a situation like this. Other than going with her, helping her to navigate the medical-ease and holding her hand what can I do for her during this time? I'm just so very sad for her and want to do what I can to be of some comfort to her.

posted by teamnap to human relations (19 answers total)

Helping her navigate the medical-ese and holding her hand is a lot.

If you work in cancer medicine, you will know the name of the late, great Dr. Judah Folkman, but you may not have run across his advice for breaking bad news to patients. It's aimed primarily at physicians rather than friends or family members, but if her oncologist isn't so great at this part of the job, maybe you can help fill in the gaps.
posted by timeo danaos at 5:19 PM on December 31, 2011 [34 favorites]

You aren't her doctor. However much you may know about this particular cancer, you aren't her doctor. It's not your place to tell her how long she may have to live.

If you want to be a friend, stop hand wringing and anticipating the worst. If you really want to be her advocate, you need to be a cheerleader too. Pessimism doesn't help people beat cancer.

If you really need to be active in this process, plan on being her rock for the duration of this cancer. She's going to need you to drive her to chemo, hold her hand in hospice, cook, clean, or fight her insurance company for her.

I'm so sorry. Fuck cancer.
posted by JimmyJames at 5:25 PM on December 31, 2011 [8 favorites]

Speaking from some personal experience, it's very difficult to navigate that line between being your friend's advocate and being so empathic that you feel the bad news is directed to you. She obviously trusts you enough that she wants you to hear the prognosis with her, so you can help her understand it, comfort her, listen to her vent, and so forth. That is no trifling matter as it puts you in a central role in her life going forward. But it is also your role, as her advocate, to think of and ask the questions she may be too blown away or emotional to ask. Again, speaking from experience, if you can spend some time in advance thinking of what those questions might be, you'll be able to function more effectively on her behalf.

My best wishes go out to your friend, and to you.
posted by DrGail at 5:25 PM on December 31, 2011 [1 favorite]

When I, or friends, have gone through a crisis, we have noticed that the person at the center of it can become exhausted from dealing with others' feelings about it. People want to walk into the room, say, "Oh my god I'm so sorry," and give the person a big deep heartfelt hug, perhaps with tears. This can be really overwhelming to someone who is having to deal with their own feelings about what is happening, or who has had a dozen such visits already this week. One thing a good friend can do is offer to run interference with visitors or phone calls, including steering the overly emotional away from the person, being the clearinghouse for information going out, or being the person people can be sent to if they need to talk. During a long crisis of my own, for instance, I had a small support committee, and when people called me I could refer them to the members of that committee for the full information updates or to vent their own feelings about the situation. It was a big help.

The corollary to that is that, if you are going to be a primary support person as your friend's illness continues, you might be thinking now about who can be your support person or people. Who can you take your own feelings of tiredness, sadness, and so on to, so that you can be calm when you're with her? Who can be available to help you with any practical needs you might have, like childcare or whatever, so that you can be free to sit with your friend, go to appointments, or whatever? I remember the first time I was a support person for a friend in crisis, I felt like there was a pyramid: my friend at the pinnacle, and then me and a couple of other close friends doing hands-on, intense work with her, and then all the people who stepped up to help those of us in that inner circle--some of whom had never even met my friend, but were doing it out of their affection for me--deal with the disruption to our own lives.

A useful book about helping a friend through a health crisis is Share the Care. It talks about how to organize a support group, and how to navigate the issues that can arise.
posted by not that girl at 5:40 PM on December 31, 2011 [27 favorites]

My mother went through this with her best friend and looking back, the single best piece of advice I have for you is: meet her where she is. My mother's friend was told it was terminal cancer with my mother right there in the room; there was really no prevaricating. My mother's friend's response was "what are the treatment options?" In other words, this friend chose to go through fairly pointless chemo before really accepting her diagnosis, and my mother's job was not to say "are you crazy?" (and she kind of was) but rather "right, let's get you a hat and some socks and some research you asked for on this kind of chemo and here, have a Quesey Pop." Crucially, my mother also did not release information about the prognosis before her friend did.
posted by DarlingBri at 5:58 PM on December 31, 2011 [9 favorites]

What a terrible situation for your friend and how good of you to step up. Your being there will be a great comfort.

Your friend may eventually have a lot of questions, as you will know, but you may find that she is asking the same questions, of you and of her doctors, time and again, maybe in slightly different forms, as she tries to process the news. If you notice any signs of impatience on the part of those being questioned (which obviously there shouldn't be, but I know from experience some consultants in particular seem to lack the abilities outlined in this link from timeo danaos) then this is where you can act as her advocate to shield her as best you can from feeling like a nuisance or that she shouldn't be asking so much - she has every right to ask.

Alternatively, she may seem to shut down and internalise everything, not just in the meeting but afterwards. A close colleague at work was diagnosed with cancer a year or so back and despite being one of the most chatty people going, really didn't want to talk to anyone about what was happening, even to the extent of never actually telling people what type of cancer she had. In line with Not That Girl's good suggestions, this friend had her sister liaise with one or two people at work who acted to disseminate news about operations and treatments until she was well enough to make contact herself. If you or a family member or another friend can take on, or share, this role, I can only say it seemed to work well for my colleague.

I know through your job you may well have much better resources available to you than most people that you can share with your friend but the Cancer Research UK site has some excellent advice and guidance for people living with cancer and their friends and relatives; one good piece of advice I read recently (might even have been on this site) was to stick with the "good" websites, like CRUK and the American Cancer Society one and not get drawn off onto more obscure sites.

My very, very best wishes to both your friend and you.
posted by Martha My Dear Prudence at 6:05 PM on December 31, 2011 [1 favorite]

Apparently, one factor that makes a BIG difference, is if the patient has HOPE. Not just hope for recovery, but a positive attitude makes the ordeal itself more bearable. In other words, I also think you should quit it with the hand wringing.

I'm being blunt because I don't want you to underestimate how important a positve attitude can be, no matter the diagnosis. And not fake positive, because that's unnerving to be around. If you don't think you can handle this news well enough, or that your reaction will have an adverse effect on your friend, you should help her find someone else to go with her.

It's OK for you to require support, but this isn't about you. If you can remember just this (that this isn't about you) and you can take your cues on how to respond to any news strictly from your friend, I think you'll do just fine next week.
posted by jbenben at 6:24 PM on December 31, 2011 [2 favorites]

Bring a pen and paper. She's going to be overwhelmed and won't remember everything that is said to her, and if you can write it down and recount it to her when she is more able to hear it, that will be invaluable. This type of news needs to be absorbed a few times.
posted by heatherann at 6:34 PM on December 31, 2011 [8 favorites]

Your friend is lucky to have you. I'd suggest taking notes at any appointments you attend because the information may be hard to remember if you and your friend are both emotional and/or in shock.

A few suggestions based on personal experience:

- Set up a site at someplace like lotsahelpinghands.com so people can sign up to visit, bring meals, and do other things to support your friend.

- If she has kids, help set up 529s for them. I did this for a friend and sold her on the idea by saying that she probably hadn't had time to do it because she'd been so sick (we never talked about how poor her prognosis was). When she did pass away, this allowed people to help out her kids, who will really need it down the road.

- Help set up a blog so that family/friends can follow her treatment without bothering her with lots of phone calls. I've had friends do this both with and without restricting access (using Blogger) and it was so helpful for everyone involved.
posted by mingshan at 6:38 PM on December 31, 2011 [2 favorites]

Thank you all for the responses. I am finding them very helpful.
posted by teamnap at 6:57 PM on December 31, 2011

My mother went through this with her best friend and looking back, the single best piece of advice I have for you is: meet her where she is.

I want to underscore this. If your friend wants to talk treatment options, then you are there to discuss them, gather information about side effects and possible outcomes, etc. If your friend wants to talk palliative care only, then you are there to gather information about hospice, pain management, etc. Especially in this early stage, in which she's going to be in shock no matter what the information is, don't impose your point of view on her. This includes going straight into hyper-optimistic cheerleader/WE'RE GONNA FIGHT AND BEAT THIS THING NO MATTER WHAT!!!!! mode, if that's not where she's at. When I was diagnosed with cancer early last year (but before we knew exactly what stage it was; it turned out to be stage II but for awhile it was conceivable it was stage IV), it was immensely important to me to be given the mental and emotional space to ponder what my limits might be in terms treatment, based on how I weighed quality of life vs. quantity of time.

Or, to be more blunt: if she needs to talk about dying, then let her talk about it; do not try to shut her down in the name of "optimism." It may very well be that the single most supportive and positive thing you can say to her is that whatever happens, you will support her choices and will help her be in control of as much as she can control.

Beyond that: as mentioned upthread, the next most important thing to do is to offer to be the coordinator (or to find the coordinator, if you can't do it -- and be honest with yourself on this score) for things like organizing rides to treatment, organizing friends and family to bring food, running errands, etc. I was very moved but also very overwhelmed (literally) with all the offers of help I received in the aftermath of my diagnosis, and at times it got very exhausting and upsetting to essentially have to be my own project manager, as it were. If you can be or find this person for your friend, this is going to be one of the most important gifts you can give her.

My best to you and your friend.
posted by scody at 7:18 PM on December 31, 2011 [20 favorites]

As the daughter of Denethor, (the ruler who yells DOOOOOM! Give up NOOOWWW! to his people in Lord of the Rings), I suggest just letting her process it herself, in her own way. I cannot TELL you how awful it is to have someone constantly telling you that you just don't understand the gravity of Situation X. Yes, actually I DO understand, Mom! I just don't chose to have it ruin every minute of every day. Stop telling me how to emote.

/projecting
posted by small_ruminant at 8:34 PM on December 31, 2011 [1 favorite]

My answer would be the same as scody's (and several others'), with this small addition: as time goes on, be sure to re-assess what your friend wants/needs, and change your role accordingly (if necessary). What she needs from you may evolve as her condition does. For example, she may start out needing a cheerleader, but after time may need someone to sit quietly with. Or she may start out needing you as a source of information and advice about her condition, but later need someone to talk with about anything but that.

I'm cautious about this because, from experience, I know it can be tempting to accept/assign yourself a particular position, and cling to that through the ordeal. It can be comforting to have a 'job', as it gives you a solid framework with which to deal with your own grief. But things can change, and you want to make sure you stay sensitive to what your friends needs are, even if it means doing something other than what you were originally asked to do. Even if that something is, eventually, nothing at all.
posted by ordinary_magnet at 8:38 PM on December 31, 2011 [4 favorites]

> If you work in cancer medicine, you will know the name of the late, great Dr. Judah Folkman, but you may not have run across his advice for breaking bad news to patients. It's aimed primarily at physicians rather than friends or family members, but if her oncologist isn't so great at this part of the job, maybe you can help fill in the gaps.

I've met Judah Folkman, but hadn't read this, and got teary doing so.

I had cancer this year of an absolutely not-lethal sort, and I'm terribly grateful that my doc handled delivering the news similar to this. But the hardest thing was telling other people. I was kinda okay with crying and researching and crying and coping at home, but I couldn't bear breaking into tears while delivering the news to other people; it broke my heart. Hell, random acquaintances saying "how goes it?" as small talk was hard for awhile.

Help her get to a place where she can tell her friends and/or extended family, because it's really, really easy to get so overwhelmed with exhaustion and sorrow that you just withdraw and deny yourself comfort that would make things so much easier. As silly as it sounds, practicing saying the words helps.
posted by desuetude at 10:39 PM on December 31, 2011

"When I, or friends, have gone through a crisis, we have noticed that the person at the center of it can become exhausted..."

I think you need to think beyond yourself before you take on a primary care role. The person in question is going to have a very hard time telling their family how serious it is... but in most circumstances, someone in the family should know.

See if you can't get a direct family member -- if any available -- to come along with you.
posted by markkraft at 11:15 PM on December 31, 2011

(This can also help to take off some of the burden on your friend, as a family member can break the bad news to the rest of the family.)
posted by markkraft at 11:17 PM on December 31, 2011

markkraft- Unfortunately she has no family other than one distant relative in another state. So whoever it is who takes on the primary role here, and I don't know that it will be me as I live 45m-1.5hour away from her (depending on traffic) and I have a small infant at home to take care of, is going to be a friend.

Thanks again to everyone.
posted by teamnap at 10:15 AM on January 1

Seconding not that girl on handling friends or family. My mom was diagnosed with cancer at the end of October, and the one thing that drove me crazy or wore me out were the constant repeated questions: "What stage is it?" (We didn't know yet, we had to wait for the PET scan to determine that.) "Are they going to do radiation and chemo?" Didn't know yet. I finally just said LOOK, I don't know anything but I promise you WILL hear from me when I do and I will NOT leave you out of the loop.
posted by IndigoRain at 2:32 AM on January 2

For you, take it day to day.
posted by goalyeehah at 10:44 PM on January 2