“Dear King Charles:” What Not to Say to Someone Who's Sick—and What to Say

Lessons from 15 Years on the Front Lines of Cancer

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I’ve been traveling a lot the last few months, working on an exciting, ambitious new project, so I’ve been a little quiet on The Nonlinear Life. But I was jolted back into the themes we discuss around here by a back-to-back-to-back set of events this week—all involving cancer.

The first was the news that King Charles has a second, clearly more serious diagnosis than the one he revealed only a few weeks earlier. The fact that Buckingham Palace named the last case (prostate) and did not name this one suggests a higher degree of worry. 

The second was the announcement that the 62-year-old country superstar Toby Keith died of stomach cancer just hours after the Grammy broadcast had featured triumphant appearances of numerous stars (Joni Mitchell, Celine Dion) who had recovered from medical crises.

The third was someone I know and love who received word of a possible new round of cancer many years after a previous one.

Next month marks 15 years since the end of my chemotherapy for a nine-inch osteosarcoma that was found in my left femur. For years after my treatment, I had a life rule: Have a cancer conversation every week. Do something to help someone you know; bring comfort to a family in pain; shine a light on a worthy new initiative. And while I’m not sure I still meet that pace, almost every week my phone rings, my email pings, or my social media inbox fills up with someone asking what sounds like a tremendously simple question:

My aunt, my sister, my neighbor, my son has just received a horrible diagnosis. What can I do to help?

When I receive this question, my instinct is usually to start with what not to say, since saying the wrong thing is usually what people most fear. Then I move on to what to say. So at the risk of offending anyone who may have said any of the offending items below, here are Five Things You Should Never Say to Someone Who’s Sick—and Four Things You Can Always Say.

First, the Nevers.

1. “WHAT CAN I DO TO HELP?” Most patients I know grow to hate this question because as kind-hearated as it sounds, it actually shifts the burden back on them. The truth is: The patient is never going to tell you. Among other reasons, they don’t want to admit that they need help. I was pleased when Sheryl Sandberg and Adam Grant quoted this advice of mine in their book Option B: Don’t offer to do anything, just do something: preferably something mundane like cleaning out the fridge, walking the dog, replacing lightbulbs, or changing the oil in the car.

2. “MY THOUGHTS AND PRAYERS ARE WITH YOU.” In my experience, some people think about you, which is lovely. Others pray for you, which is equally generous. But the majority of people who say they’re sending “thoughts and prayers” are just falling back on a mindless cliché. It’s time to retire this hackneyed expression. If you pray, say pray. If you don’t, just say, “I’m thinking of you.”

3. “DID YOU TRY THAT TURMERIC GUMMY I RECOMMENDED?” I was stunned by the number of friends and strangers alike who inundated me with tips for miracle tonics, Chinese herbs or Swedish visualization exercises. At times, my in-box was like a Grand Ole Opry lineup of 1940s Appalachian black-magic potions. “If you put tumeric under your fingernails, and pepper on your neck, and take a grapefruit shower, you’ll feel better. It cured my Uncle Louie.”

   Jen Lin, the founder of Cycle for Survival who went through sarcoma treatment alongside me before dying in 2011, once told of being stopped in a store by someone who said, “You don’t know me, but you’re friends with my wife. Why aren’t you wearing the kabbalah bracelet I bought you in Israel?” 

4. “EVERYTHING WILL BE O.K.” The truth is that most of us don’t know what to say in these situations, so we end up falling back on chirpy slogans – Chin up! You’ll get through this! Feel grateful every day! But these banalities are more often designed to make you feel better that us. Since you don’t know the prognosis, don’t predict the future.

5. “YOU LOOK GREAT.” Nice try, but who are you kidding? We have bags under our eyes, we have bruises all over our bodies, we’re wearing baggy clothes because of all devices that get plugged into us, and our colostomy bags needs emptying. The only thing this hollow expression conveys is that you’re focusing on how we appear. It’s understandable that you’re comparing us with your memory of us, but we don’t need to hear your report card.

So what should you say? Here are four suggestions.

1. “HOW ABOUT SOME GOSSIP?” This piece of advice has actually moved higher on my list over the years. I like to begin with some levity, if I can. “We tried to keep you out of the club, but, no! You had to go and butt in.” Imagine the sick person: On top of everything else they’re dealing with, everyone they meet is either glum or tongue-tied. By all means follow the lead of the patient, but sometimes a little humor or distraction can help. Don’t you know any gossip about that pop singer, sports figure, or disgraced pol? It can cheer the soul of someone trapped in fluorescent rooms every day.

    

2. “DON’T WRITE ME BACK.” I feel so strongly about this line that I put it in every email or note I write to someone who’s sick—sometimes in a P.S. but often in the opening sentence. All patients get overwhelmed with the burden of keeping everyone informed, coddled, and feeling appreciated. Social networking, while offering some relief, often increases the expectation of round-the-clock updates.
   
   To get around this problem, I appointed a “minister of information,” whose job it was to disseminate news, deflect queries, and generally be polite when I didn’t have the energy or inclination to be. But you can do your part, too: If you reach out to a patient, drop off a casserole, or run an errand, insist that they not write you a thank-you note. Chicken soup is not a wedding gift; it shouldn’t come with added stress.

3. “I SHOULD BE GOING NOW.” If you do stop by or visit someone in the hospital, write these five words on the back of your hand. Whatever you do, don’t overstay your welcome. If you are being asked to stick around for an entire shift, then after half a hour or so you should probably start washing dishes or watering plants. And take the trash with you when you leave.

4. “I LOVE YOU.” Finally, you’re not a poet and no one expects you to be. When all else fails, simple, direct emotion is the most powerful gift you can give a loved one going through pain. It doesn’t need to be ornamented. It just needs to be real. “I’m sorry you have to go through this.” “I hate to see you suffer.” “You mean a lot to me.” The fact that so few of us do this makes it even more meaningful.

My final piece of advice is that even if you don’t know what to say or what to do, just be present. The biggest thing people fear when they’re sick is vulnerable, unsure, alone. Your very presence says more powerfully than words, “You are not alone.”

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