What to do—and what not to do—when someone you love gets a serious diagnosis.

By Didi Gluck
Brian Rea

A quick survey of the greeting-card aisle confirms it: While there are sympathy cards and get-well cards, even the professionals are stumped when it comes to finding the right words for people who are facing a life-threatening illness.

“Serious illness makes us squirm for several reasons,” says Phyllis Kosminsky, Ph.D., a psychotherapist at the Center for Hope, in Darien, Connecticut, which offers bereavement support and help for those dealing with critical illnesses. “It makes us face our fears about our health and the health of those we love, it forces us to confront our mortality, and it reminds us that some things are out of our control.” (Hence the impulse to ask “Did she smoke?” when we hear that someone has lung cancer, even though plenty of people who suffer from the disease have never lit a cigarette.)

Despite our discomfort, 70 percent of us will care for a seriously sick friend or family member at some point in our lives, according to a survey conducted by the Center to Advance Palliative Care (CAPC), an organization that helps people living with serious illness. So how do you say and do the right thing for a loved one in need? Real Simple asked the experts for their best advice.

Offer to Help, and Be Specific

“If you say ‘Call me for anything,’ the person probably won’t,” says Kosminsky. “That’s human nature.” Instead, offer to do something concrete, like walking the dog, picking the kids up from school, or bringing dinner on Wednesday nights.

For a friend who lives far away, consider scheduling regular food or flower deliveries. Visit lotsahelpinghands.com and foodtidings.com, sites that let you coordinate a delivery schedule with other well-wishers. If you’re especially close to a sick friend, you can offer to set up a page at CaringBridge.org. This will allow her or a loved one to share updates (so she won’t have to field calls from people who want to know how she’s doing) and lets friends sign up to help with chores and errands.

Should your friend decline your offers, don’t take it personally. Sometimes sick people, like healthy people, just want to be alone. Elisabeth Kubler-Ross, the famed Swiss psychiatrist who was a pioneer in the field of death and dying, believed that it’s important to respect the desires of the patient. If you repeatedly volunteer to help and your friend repeatedly says no, then the offers can become more about your need to get  “credit” than hers to get help.

Follow Through

People generally rally after the initial bad news, but then support may dwindle. Keep offering the help you gave at the time of your friend’s diagnosis. If you’re concerned that your efforts may become intrusive, you can always say “I’m going to keep doing this until you tell me to stop.”

And whatever you do, stay in touch. “I can’t think of anyone who has ever said ‘As time went by and people kept calling me, it was such a pain,’ ” says Kosminsky. If you call, leave the best number and time to reach you (it’s exhausting to play phone tag), and don’t expect a response. Your friend may be too physically or emotionally tired to answer right away. (To avoid a faux pas, consult this list of phrases not to say to a sick friend.)

Keep on Keeping On

“The foundation of friendship is simple,” says Mary Gravina, a vice president of counseling at the Hospice Care Network, in Woodbury, New York. “Think of what brought you together in the first place, and continue to honor that in sickness as you did in wellness.” Do the best you can to keep things normal, and participate in the activities that you and your friend enjoyed when she was well, whether it’s gossiping or going to the movies.

If she’s too ill to travel to old haunts, consider re-creating those experiences bedside. Gravina remembers two friends who had boys the same age. “When both were healthy, they took their sons pumpkin picking every Halloween. But when one fell ill, the other set up a pumpkin patch on her front lawn so she could watch the boys pick from her window.” Lest you think the gestures need be grand, keep in mind these words from Ram Dass, a spiritual leader and author: “We can, of course, help through all that we do. But at the deepest level we help through who we are.” In short: Just be there. And if you listen more than you talk, a friend will often provide clues about what he needs, says Kris Carr, a best-selling author who is living with cancer and who produced the documentary Crazy Sexy Cancer.

Maintain Physical Boundaries

Use your pre-illness relationship as a guide. If you usually sit on the person’s bed to talk, go for it. If not, ask if that’s okay. Many sick people feel that their privacy is routinely violated by invasive medical tests, so their boundaries may be tighter than usual. Similarly, if a friend asks you to go to the doctor with her, ask if she would like you to accompany her into the examination room; she may prefer that you stay in the waiting area.

 

Be Supportive but Not Overly Emotional

“You should be warm and loving without putting on that hangdog face,” says Kosminsky. “When you communicate that kind of sorrow to a sick person, she ends up feeling like she has to comfort you.” Instead, be succinct and direct, saying something like “I love you, and whatever road you’re going down, I’m going down it with you.” Or simply “I’m sorry.” There will be times when your sick friend just wants to cry—and in that case it’s okay if you cry, too.

Don’t Shy Away From the Legal Stuff

This advice is clearly for closest confidants only, but helping your friend negotiate a will, trusts, and estate planning can be a great gift. “Although no one wants to talk about this stuff, it can be a legal tsunami if the homework isn’t done,” says Edward Creagan, a professor of clinical oncology at the Mayo Clinic in Rochester, Minnesota. Here’s how to bring it up, says Creagan: “Say, ‘We’re all hoping for the best, but if we go ahead and handle this stuff now, you can get back to focusing on healing.’ ” If a patient has the capacity, encourage him to see a lawyer on his own (or offer to bring him there). If that’s not possible, says Creagan, a lawyer can come to a patient’s bedside, the ER, or the ICU to draw up a will or instructions about end-of-life care.

And if you’re one of the primary caregivers for a sick friend, it’s important to talk with him about his wishes if he gets sicker and can’t make decisions, says Diane E. Meier, M.D., the director of the CAPC. If this feels callous or blunt, try saying something like “This is so hard to talk about, but if you were ever in a situation where you couldn’t make your own decisions, I would need to understand what matters most to you.” If the patient reaches a point where he will never return to his former quality of life (for instance, he is unable to interact with his grandkids), he may want care that focuses on his comfort rather than life-prolonging treatments. Both the CAPC (getpalliativecare.org) and the Hospice Foundation of America (hospicedirectory.org) can help you navigate and accommodate these decisions.

Remember Anniversaries

Sick people often focus on their diagnosis date or the date they took their news public—especially if they’ve lived past a dire prognosis, says Anna Rhodes, a psychotherapist in Seattle who focuses on the effects of stress, illness, and loss. Send the person a note or a message on that date to say “I’m thinking about you.”

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