A Difficult Conversation

The painful emotions following a loved one's diagnosis stop us from connecting when it matters most, a SELF poll reveals.

I remember the call as if it were five minutes ago. A close friend was on the line, telling me her husband had brain cancer. It was 1988, and cancer still wasn't talked about much, by celebrities or anyone else. I mumbled that I was sorry, that I loved them both, and said I'd be there for her over the long haul.

It wasn't very long, as it turns out: only six months. They were awful for him, of course, but also for anyone watching because a weird veil of secrecy surrounded it all. Although their doctor informed my friend that what her husband had was fatal, he advised that she not tell him so as to leave him his hope. Her husband didn't want visitors, so none of the people who knew and loved him got to say a proper good-bye. "It was as if we were keeping a terrible secret," she says. "Even from ourselves. In a way, that was harder than seeing him slip away."

Since that time, there's no question cancer has come out of the closet. Sheryl Crow and Melissa Etheridge were onstage months after announcing the battle of their life. Survivors have babies, write memoirs and hit the campaign trail. Yet despite cancer's ascent into the public consciousness, the pink ribbons, celebrity spokespeople and races for the cure, many of us still struggle to cope when people we know are diagnosed. According to a new SELF poll, 69 percent of readers who have never had cancer say they're unsure how to comfort someone in treatment. (Amazingly, 41 percent of survivors share this uncertainty.) And 35 percent of women who haven't had cancer say the worst part of watching someone battle the disease is the sense of helplessness. Given that a third of women will get cancer in their lifetime, that's a lot of missed opportunities for offering comfort. Why does the disease leave us feeling so powerless?

Our own fear of death, for one thing, can get in the way of being the friend we'd like to be. In SELF's poll, 92 percent of women who haven't been diagnosed with cancer are very or somewhat worried about getting the disease, and 30 percent see it as an automatic death sentence, despite the fact that half of survivors now live long enough to eventually die of something else. "We're shifting our thinking from looking at cancer as a terminal illness to a chronic disease," says David Spiegel, M.D., professor of psychiatry at Stanford University School of Medicine in California. "But it still scares the hell out of people. A diagnosis provokes a kind of existential emergency—it gets us thinking not only about the patient but about ourselves."

Our familiarity with the side effects of chemotherapy and radiation only heightens this trepidation. "When you tell someone you have it, they imagine bald heads and nausea and think, God, I hope I never have to go through that," says Julie Anthony, 59, a nine-year breast cancer survivor and psychologist in Aspen, Colorado. Perhaps that's why 15 percent of women who haven't had cancer say they wouldn't mention the diagnosis if they bumped into an acquaintance with the disease. Even a simple "I'm sorry" can prove challenging when we're thinking, I'm scared—because I might lose you and because if you got cancer, I could, too.

Such unconscious, almost primal, anxieties can cause seemingly stalwart friends to disappear in the wake of a diagnosis. When doctors discovered she had stage IV non-Hodgkin's lymphoma two years ago, Caroline Neely Rose, then 27, of Pasadena, California, says an old friend simply vanished. "I was a marathoner who didn't smoke and rarely drank, and I think my diagnosis really freaked her out," she says. "When I got married four months after my last chemo treatment, she didn't even show up at the wedding. To this day, I haven't heard from her."

That doesn't surprise Marisa Weiss, M.D., a breast radiation oncologist in Narberth, Pennsylvania, and founder of BreastCancer.org. "Sometimes people you depend on disappear because they feel threatened, while those you never paid much attention to roll up their sleeves."

I don't always get it right myself when someone tells me she has cancer. I might be a tad grave and teary or, other times, I'm too cheerful and blurt out a sunny "I'm sure you'll be fine." Patience Moore, a 45-year-old two-year breast cancer survivor and singer-songwriter in Montclair, New Jersey, says she hated that kind of reaction from friends. "Saying I'd be fine raised the possibility that maybe I wouldn't be fine."

Moore says other friends praised her strength, but she expresses skepticism that her attitude could have affected the course of her illness. "People would always say things such as 'You're up for the fight.' That felt like pressure to get better. But getting better wasn't in my control. It was about the medication and the disease." Although 91 percent of survivors in the SELF poll say patients with a positive attitude are likelier to recover, there is no evidence that being positive affects survival rates. "One of my patients began to cry after getting her diagnosis," Dr. Spiegel recalls. "And her husband said, 'Don't cry. You'll make the cancer spread.'" These misconceptions give the illusion of control and, for survivors, perhaps, the false hope that they can make cancer retreat by adjusting their outlook. Startlingly, a greater number of survivors than women who've never had cancer say people bring the disease on themselves (25 percent versus 17 percent) by, for instance, leading a stressful life. "In an effort to understand and gain control of what seems unexplainable, patients may point to a possible danger such as drinking well water, or even a stressful event like a divorce, as having sparked their illness."

Our desire to pinpoint a cause may also spur us to cast blame on the patient. In the SELF poll, 61 percent of women who haven't had cancer say that their first thought upon hearing a lung-cancer diagnosis is to ask themselves, "Did she smoke?" That may be natural with smoking and lung cancer, but we also make this kind of cause-and-effect leap with other cancers. "When Elizabeth Edwards was diagnosed with breast cancer, I heard women say, 'She didn't get mammograms. She used fertility drugs,'" Dr. Weiss notes. "They tried to come up with an explanation to reassure themselves that if they did everything right, they'd be safe."

I've done that, too, albeit in a grumpy, loving, "Damn it, why didn't you get your mammograms, because I hate it that you have cancer!" way. But I'm getting better. Two years ago at a dog park, I became friends with Caroline Neely Rose, newly married and in remission. Then her cancer came back, and she went home to Texas for a bone marrow transplant. We—her friends—stayed connected to her through CaringBridge.org, a website that let Neely Rose create her own page. I'd read her reflections online and think about what a far better world it is today for cancer patients than it was when my friend and her sick husband battled in secrecy. Neely Rose taught us all a grand lesson: that we could, with her help, stare cancer—stare death—in the face and not blink, and that there was power in the not blinking. Says Neely Rose, "To be able to share my progress with people I love and know that they are praying for me...nothing's as important as that."

Learn more about a loved one's diagnosis by signing up for a workshop at CancerCare.org.

Help a coworker cope with cancer: Go to CancerAndCareers.org.