Who speaks first… about cancer?

There is Bob, across the room.  Darn, its must be true, because he is as bald as a cue ball. What do you say?  “How’s the cancer, Bob?”  “Throw up much lately?”  “How about those Mets?”  You do not want to say something stupid, do not want to get Bob upset, so, you do not meet his eye and do not cross the room.  Causally, leisurely, so as not to be noticed, you skulk into the kitchen.

You see Stan across the room, the first time since your diagnosis.  Darn, you really do not want another non-cancer, cancer conversation again.  You know the kind, where they talk about everything except the fact that you are bald as a cue ball.  Should you mention the chemo? Talk about the disease?  Do not want to get Stan upset.  Just want to be treated naturally.  So, you do not meet his eye and do not cross the room. Casually, leisurely, you retreat into the corner.

ATTENTION CANCER PATIENTS – I wish I had better news, but I do not.  The reality is that if you ever want to have a real conversation again, if you want friends, if you want to talk about what you are going through, than you must start the conversation.  Otherwise, everyone will dance around the elephant in the room, and frankly, that elephant is you.  You must give others permission to talk and permission to care.

The key is to convey that if someone mentions cancer that you are not going to collapse to the floor or burst into flames.  People need to know that most of all you are still “Bob”, a real normal person with a terrible golf game and a love of gardening, who just happens to have a medical problem.  They need to know they can talk to you and give you support without the conversation descending, necessarily, into tears.

While others want to reach out to you, they would probably prefer if you do not answer the first honest question, such as “I heard you have prostate cancer, how are you doing,” with  “I am looking forward to my wake.”  Nevertheless, they know you are going through something hard and they would very much like to touch your heart, to support you; it is just that often they do not know how.

“Hey, Stan, how are you doing?”

“OK, Bob …ah…ah… how are you?”

“I am doing OK, but I guess you heard that I am being treated for lung cancer?”

“Yeah, I heard…I am sorry.”

“Well, it’s not your fault.  I started on chemo last month.  I’ve had some tough days, but I am fine right now.  Its really nice to get out and see everybody.”

“Are you going to be on chemo for a while?”

“The doc says a few months, it depends how well it works.”

“Well, if it works as well on the cancer as it did on your hair, you should already be cured.”

“Yeah, it’s the new me.   I always was a Yul Brynner fan.”

“How are your wife and kids holding up?”

“Well, it’s hard on them, but we get by day to day.”

“What can I do to help?”

The message is that while almost everyone you meet would like to support you, you are going to need to give them permission and, for many people, show them how.  That means you, the patient, needs to open things up.  Now this will not work all the time, for some people cancer is so frightening that they will treat you like a china doll.  That is their problem and should not be allowed to become yours.  However, most people can be taught that you are still a person, still capable of humor, intelligence and hope, and the friends and companions you gain will help carry you forward in your fight to become healthy, once again.



  • Can only agree. Cancer patients have to lead the dance, adjusting it to the circumstances and the people. Some of my friends share my taste in dark humour, which I once employed in a meeting, when we were discussing some hard issues, and I referred to the Neitzche line, 'what doesn't kill you makes you stronger,' just like chemo. After a nervous laugh, the point worked and we got past the issue. Some of the liberties we people living with cancer have (but should deploy cautiously).
    • James Salwitz, MD
      Thanks for you insight. There is so much truth in the Nietzche quote that it hurts and an infinite need for humour. Jcs
      • We hope that we don't need to get any stronger! Doc you know what we mean. Linda & Walt
        • James Salwitz, MD
          I think you have done your share ... If there is any justice you should get a free pass ... Or two. Jcs
  • Steven Carr
    Good article - a situation we all experience. - I played in a pool team, good bunch of lads, always good for a laugh, though I had not played for about a year before I was told that I had leukaemia. So to cheer myself up, and knowing that there was a pool match on, I went down to the club and stood at the bar, chatting to the barman and a few of the locals. After about an hour, I caught out the side of my eye, one of my old pool mates ' bounce ' off the invisible barrier that had suddenly surrounded me, It then dawned on me that none of the team had been to the bar since I had arrived. I went over to them and asked if we were still friends .... surely we were not going to let a little bad blood come between us .... the barrier disapeared.
    • James Salwitz, MD
      Thanks for your story...particularly interesting because a bar can be such a reflection of our society...it can be very social or it can be very lonely. Jcs

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