What do I say to my friend who's likely dying?

November 9, 2023 9:18 AM

A friend moved back to Australia to deal with her breast cancer. It seems to have spread and unfortunately we now believe it to be terminal. I'm trying to be there for her, but have no idea how to do that.

She doesn't like to give us details, but she did mention that one of her doctors told her a month or so ago that she should "go out and live her life as much as she can" and she said that she felt like the doctor was giving her a death sentence, but then also said she was going to a different doctor because she didn't feel confident in that one.

She had said previously that it was metastatic, so we believe that she wasn't able to accept the unfortunate reality of her situation (understandably), and she kept talking about coming back to NY where she has lived most of her adult life (she's in her 40's). Because of the time difference, we've been mostly exchanging texts rather than phone calls, and yesterday she send me a pic of her lying in a hospital bed with pneumonia. I don't know if this means the end is near for her, or if it's one of those things that happens and then gets better. Just a few weeks ago she was traveling around Australia visiting friends and feeling great after having gone through chemo, a mastectomy and then radiation.

She won't talk directly about her prognosis, but will say things like she's having an emotional day, or she's trying to deal with the situation, and doesn't really want to talk which I interpret to mean she's trying to come to terms with it.

Now for my question, I want to support her as much as I can, but I have no idea what to say to her. I don't know think that uplifting platitudes would provide much comfort, but maybe they would in a way that I can't think of to say them? I've told her already that I'm available night or day if she wants to talk, but I don't know if she's there yet.

I've thought about telling her how I'm feeling when we're texting, but it's mainly that I'm so sorry that she's going through this (which I've said to her multiple times and can't just keep repeating) and that I miss her and am going to miss her when she's gone, but that feels selfish to say, and since she hasn't directly told anyone her prognosis doesn't seem right to say.

Sorry if this question is all over the place, I'm just feeling lost and want to provide as much comfort to my friend as possible. What should I say to her? How should I respond to seemingly awful news that I'm not sure she's accepted yet? Any and all suggestions welcome.

posted by newpotato to Human Relations (15 answers total)

Best answer: Sorry that your friend is facing this, especially at such a young age.

At this distance and with limited information, I think that you let her take the lead in terms of conversations. I doubt she wants to put this at the forefront, so if she's not "there yet," then that's OK - be where she is. You don't have to take the role of helping her get there / helping her confront her diagnosis unless she invites you there.

The best thing you can do is just treat her as you always have. If there's something you want to say (e.g. "I love you, you mean a lot to me") that you need to make sure you say, then try to find a way to say it that doesn't outright say or imply you're saying it because you think you won't be able to soon.

Instead of "I'll miss you when you're gone," say "thanks for the texts, love hearing from you - wish you were here!" and so forth.

I really only had the "I'm going to miss you" conversation with my friend once. She opened the door, by telling me she was afraid. I think I probably botched that conversation, by trying to steer it away from her fear of dying. So my best advice here is let her lead, but look for a way to say your "I love yous" without talking about mortality unless she wants to.
posted by jzb at 9:32 AM on November 9, 2023 [12 favorites]

Best answer: Behave normally. Have normal conversations in the style that you have had for years. Do not mention treatment or possible futures unless she brings them up first.

Basically, if she's terminal and wants to be in denial about that then nothing is gained by trying to contradict her. Enjoy your time with her and let her reach out about her diagnosis when and if she's ready.
posted by Tell Me No Lies at 9:32 AM on November 9, 2023 [18 favorites]

I'm sorry your friend is going through this, and that you are also facing the possible loss of your friend.

I have an acquaintance who is metastatic but has put a lot of energy into research, advocacy work and clinical trials. I see her often tag metavivor, that might be a good place to read up and get some perspective on stage 4 metastatic breast cancer. There are a lot of stories from women living with the disease that may provide some helpful insights. There is no cure, but that doesn't mean she's necessarily at her end stage. It's possible she doesn't tell you her prognosis because it's probably not a super clean timeline, and there isn't a lot to be gained by focusing on a very imprecise ticking clock.

I think the best way to support is to follow her lead - go deep if she wants to, but otherwise just be a friend and interact with her as normally as possible. Some days she may want to share and get support, and other days the greatest gift you can provide may be helping her feel like herself and get a respite from being a "sick person." A lot of folks focus on the sick part after a diagnosis like this, but she's still her. Her illness is not her identity, and moments where she can connect with her true self without the shadow of what looms taking up the frame are very precious. Let her decide when the shadow creeps in.
posted by amycup at 9:45 AM on November 9, 2023 [3 favorites]

I'm sorry that your friend is going through this. I don't have any advice except maybe suggesting that you figure out if you can travel to Australia to spend time with her in person.

Some good points above. She's still the same person - talk about the things you've always talked about. This essay, written by a dear friend as she was dealing with a terminal prognosis may help give some perspective.
https://medium.com/@madolan/a-tombstone-head-and-a-graveyard-mind-159b18ff3f0a

Of course this was my friend's perspective, not your friend's perspective.
posted by ewok_academy at 9:46 AM on November 9, 2023 [1 favorite]

I personally think that “How are you feeling today?” let's her decide how deep she wants to go into it and makes the conversation feel less like you're skating around the reality. I would think that touching upon shared memories or updates about common friendships would be “normal” and welcome.
posted by brachiopod at 9:49 AM on November 9, 2023 [4 favorites]

So even though it's considered incurable, people can live with metastatic breast cancer literally for decades. It sounds like you don't have enough information to know what "the reality of her situation" is. People also live past their doctors' predictions all the time. The kind of cancer I have has a 14% twenty-year survival rate. Those are all people who would have been told they had two years to live because that's what they were telling people who were diagnosed then. I personally know people who were told they had two years to live ten years ago. So the first thing I'd say is don't assume you know more than she does about her outlook and don't assume that any optimism from her reflects a lack of "acceptance." I know you don't mean it that way, but it's frankly insulting to think you know more than the patient.

The other thing I'd say is to treat her as normally as possible unless she asks for something different. The friends I'm drawn to and treasure right now are the ones who I can laugh with - including laughing about having cancer. I've always laughed about everything with my friends, and I'm not stopping now.

I've just quit sharing medical news with the friends who very obviously feel sorry for me. Those are the people who make me feel like I have to take care of their feelings - and I just don't have patience for that anymore.

I don't know how helpful this can be - your friend is obviously not me. But these are my thoughts.
posted by FencingGal at 9:50 AM on November 9, 2023 [17 favorites]

Best answer: Her prognosis is a red herring. She sent you a pic of being in hospital with pneumonia so talk to her about pneumonia and hating being in hospital and how she looks better than someone with metastatic cancer and pneumonia who's just been gallivanting around Oz has a right to look.

In general, tell her about what you've been reading (if you're book people) or about how obnoxious your obnoxious mutual friend is being, or that women in some states at least might hold on to their agency for a while yet, or whatever else you talk about. Instead of bringing sympathy, bring curiosity: ask her for stories about the friends she's visited, her impressions of the wild landscapes in Australia, etc.

Do not say you're going to miss her when she's gone. Please do not say that. Say - at the end, if you are invited "in" to that experience in any way - that she is leaving a profound impact, that she has touched many lives literally around the world, that you've learned xyz from her (grace, how to really live, etc.), and the like. If she's traveling when she can and showing you pics from acute illnesses, she is absolutely not ready to hear about how other people will feel when she is dead.

Cancer is never a straight downward line. If she gets through pneumonia ok, the meds she's been getting for that may have given her immune system a boost and she may rally again for another adventure. Set aside your expectations about what a cancer death looks like and remember that you have a living friend in front of you. Trust me, she doesn't need anyone to remind her of her condition. If she escapes it for a moment or day or weekend, let her have that.
posted by headnsouth at 9:56 AM on November 9, 2023 [17 favorites]

Best answer: Try to separate how you are feeling about what’s happening from how you feel about her as your friend. Spend time talking about things that have held your friendship together, like your mutual interests, friends, places you both like, things you’ve done with her in the past and things you want to do that you know she would like to hear about if she’s around when you do them. Don’t keep your sadness and grief bottled up, but try to express them to people who can support you that are outside of this relationship, like your family, or non-mutual friends. I don’t mean that you should be relentlessly chipper towards her, but unless she leads the conversation to her illness, fill it up with reminders of things, people, and places she enjoys and can think about when she is resting. Complaining about typical stuff can be good too, to convey normalcy and a feeling that the world continues to spin.
posted by Mizu at 9:58 AM on November 9, 2023

I'd try to act like things are usual and let her take the lead on what she wants to talk about. The advice here is very good.

One friend of mine has a husband who's dying and she laid it out for us that she'll talk when she wants to, but sometimes she just wants distraction. Fine by us, we let her take the lead on what she wants to say. Maybe have some kind of "what do you need from me?" conversation with her if you fee like you need to.
posted by jenfullmoon at 10:02 AM on November 9, 2023 [1 favorite]

Best answer: I've thought about telling her how I'm feeling when we're texting, but it's mainly that I'm so sorry that she's going through this (which I've said to her multiple times and can't just keep repeating) and that I miss her and am going to miss her when she's gone, but that feels selfish to say, and since she hasn't directly told anyone her prognosis doesn't seem right to say.

So the people who tell me they're sorry are the people I don't give any negative health information to if I can possibly avoid it. In fact, when things aren't going well, I avoid them altogether. I wonder if your friend has the same reaction and if that's one reason you don't know much. I thought maybe it was just me who hates "I'm sorry" so much, but then I heard a woman on a podcast who also has cancer who says she hates it because it feels like it takes all of her power away.

For some reason "that sucks" or "that blows" lands much better for me - but only in response to specific information, like bad blood tests - not as a general way of responding to my life.

Your friend was traveling and feeling great a few weeks ago. If she can get through the pneumonia, it doesn't sound like there's any reason to think she won't be getting back to that. I would suggest that you try to get away from thinking of her as someone who is dying. As I said, people with metastatic breast cancer can live for decades. How would you treat an otherwise healthy person who landed in the hospital with pneumonia? Treat your friend like that.
posted by FencingGal at 10:24 AM on November 9, 2023 [9 favorites]

Here is a book that can help with conversations.
Listen, by Dr. Kathryn Mannix

She's great. Her first book, With the End in Mind, is really tremendous and you may find it helpful, but it doesn't seem like it's quite on point for your current issue.

In hospice volunteer work, I learned to say "What have the doctors told you to expect?" not to find out the exact prognosis, but because the answer to that question will tell you where the person is with their own processing. That might or might not help in your circumstances, but I'm throwing it out because it has been helpful for me in so many different situations.
posted by janey47 at 10:55 AM on November 9, 2023 [5 favorites]

I would suggest that you try to get away from thinking of her as someone who is dying.

Yeah, I can't speak to this from the "person with incurable cancer" perspective but my husband died of cancer and I have a close friend who is living with metastatic cancer (this friend is likely to live for years, maybe decades). As the friend I find it more useful to focus on the "I am glad this person is alive and talking to me today" part rather than the "I am going to miss this person when they are gone." Eventually my husband *was* actually dying and that shifts the way you talk about these things (and also, you know, he was my husband and life partner so I had more intense conversations with him than I do with my friend).

It's not really clear from what your write what your friend's actual situation is. Like, yeah, "Go out there and live your life" could have the subtext "because you don't have much of it left" but it could also be more like, "we've done everything we can for the moment, so enjoy this break in your treatment." And either of those subtexts could feel very frustrating for your friend!

So basically, yeah, your friend could be in denial, but just because she has metastatic cancer doesn't mean she's actively dying. And even if she's dying, that doesn't mean that's the only thing she wants to talk about.

Right after my husband was diagnosed, I read this great essay by Sarah Hughes, Game of Thrones, cancer and me… and it's still so good! She and my husband did both survive to see the end of Game of Thrones (and perhaps to regret spending 15 hours of their precious lives on that stupid final season). She died in 2021 and her memoir was published in 2022 (I've only read excerpts, I think it might not have been published in the US).
posted by mskyle at 11:18 AM on November 9, 2023 [4 favorites]

So I am currently facing the upcoming death of a loved one. There is a poem I’ve been reading a lot - Late Fragment by Raymond Carver:

And did you get what
you wanted from this life, even so?
I did.
And what did you want?
To call myself beloved, to feel myself
beloved on the earth.

With this on my mind, I am using the test:
Will this make them feel beloved?
As the guidepost for my communication.

I realize this doesn’t give you any direct things to say, but in consideration of your friend, perhaps you can ask:
In this moment, what will make them feel most beloved?
posted by hilaryjade at 11:47 AM on November 9, 2023 [16 favorites]

this may be a useful epi; buddhist talks about working hospice during the peak of AIDS. a lot about listening, and also about letting go of expectations. (also on apple/spotify)
posted by j_curiouser at 12:45 PM on November 9, 2023

One of my longest-standing friends recently told me he has emphysema, and that the prognosis is not great.

This obviously sucks. Thing is, he already knows exactly how much it sucks, so I don't need to remind him of that in any way.

I completely trust him to be the best judge of his own treatment options, and I'm sure he's already much better informed about the condition than I am, and I don't propose to offer advice, nor inquire as to his current state of health, except and unless I'm explicitly asked to. I love this man dearly, his health is not about me, and I'm not about to make it about me.

A band we're both committed fans of looks like it might be doing a long-postponed re-union gig some time early next year and I expect we'll both go, continued existence permitting.
posted by flabdablet at 11:36 PM on November 9, 2023 [2 favorites]