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Summer 2005 Volume 6, Issue 5:
Patient Perspective: Cancer Etiquette
By Roseanne Kalick
The question most commonly asked of a patient is, “How are you?” There is inherently nothing wrong with such a question. But is it the standard “How are you?” we routinely ask when we aren’t really interested in the answer? Is it the mundane “How are
08.30.05
What to Say, What to Do When Someone You Know or Love Has Cancer

We’ve all made verbal mistakes. The goal is to lessen our chances for verbal blunders. The most likely time for error occurs when a family member, friend, or colleague tells of his diagnosis. Casual acquaintances usually find out after the dust has settled, but those closest to the situation, whether prepared or not, are likely to react viscerally. Even the period before the test results come in may be a volatile one. If, for example, you say to your friend who’s awaiting biopsy results, “It’s nothing,” you’re denying the very real anxiety felt by the person awaiting those results.

As one who was told by many, “It’s nothing,” and found out twice that “nothing” was really something, I recommend saying, “It’s likely to be nothing serious,” or “I hope it’s nothing.” This changes wishful thinking into a reality check. It may not be wise to say, “You’ll be fine.” “You’ll probably be fine” is a better choice. The first statement makes you sound omnipotent. Of course, you want the patient to be fine. You can’t deal with the possibility that she won’t be fine any more than she can. Assuming everything will be all right, however, doesn’t give the patient “wiggle room.” How can he speak to you of his fears of treatment, of dying, of disfigurement, if you say everything will be fine? It shuts down the communication artery, which is exactly what you don’t want to do. Changing one word can change the tone of the message.

Remember that waiting for test results gives new meaning to Einstein’s theory of relativity. This is a particularly stressful time. The cancer clock is on for the patient.

There are no absolutes, just guidelines. One size does not fit all. One guideline may be that less is more. Pause before you speak. It’s perfectly OK to say, “I don’t know what to say.” There is no single perfect response, no litany for proper speech. Everyone is in a state of shock when a diagnosis is made. The patient, too, may not know what to say. Your response could be as simple as “I’m sorry to hear that.” If you’re a close friend or member of the family, an expletive may communicate what you need to say. A hug may be just the right response.

A screaming toddler is told by his parents, “Use your words.” We need to do the same. Although cancer is no longer the silent disease, it still, in many instances, strangles us verbally and emotionally. It should not be a disease of miscommunication as well as runaway cells.

How Are You?

I would be remiss if I did not include a reference here to the question most commonly asked of the patient, “How are you?” There is inherently nothing wrong with such a question. But is it the standard “How are you?” we routinely ask when we aren’t really interested in the answer? Is it the mundane “How are you?” where the expected reply is the one word “fine,” or “OK?” Or is the actual question, “How are you, really?” A variation could be “How are you today?” This permits focus on a cancer snapshot rather than the entire album. Recovery is measured in small steps. Just adding the word today may give your friend an opportunity to indicate progress in the last 24 hours. Conversely, if it’s been a bad day, you both are speaking of only one day; the implication is that tomorrow might be a better day. In any case, if you ask the question, be prepared for the real answer. The question does connote caring and concern. It is often the way that communication starts. In general, if you’re not prepared for the answer, don’t ask the question.

It’s critical that even the “How are you?” question be an open-ended one. As a patient, I needed to know there would be space for my truth, my words, whether they were upbeat or not. The “How are you?” question should give me the opportunity to speak of my fear, concerns, and even anger. We may all be in denial about cancer at times, but as a friend, caregiver, loved one, you need to let me know that I can have my moments of truth, painful as those moments might be. Good words can do that.

Avoiding Errors Excerpt from "Cancer Etiquette: What to Say, What to Do When Someone You Know or Love Has Cancer" by Rosanne Kalick. Copyright 2005 Lion Books. Reprinted by permission. The book is available from Lion Books, 210 Nelson Road, Scarsdale, NY10583, or from your local bookstore. If you purchase the book online by visiting http://amazon.myeloma.org, a percentage of your purchase will go to support IMF programs and services.


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