Someone you know is sick, and you aren’t sure how to approach the subject. Should you wait for them to bring it up? Avoid it altogether so you don’t make them uncomfortable? What if you accidentally say the wrong thing and damage your relationship in a moment of crisis?
Questions like these are important. They’re a sign that you care. While no one has all the answers, there are some guidelines, borne out of experience and supported by research, that may help you be present for someone who matters to you.
Here are some things to keep in mind when you want to comfort and encourage someone who’s sick.
A serious illness can take up a lot of space in a person’s life, whether a full recovery is just a few days away or the condition is chronic. For that reason, it’s especially important to be sensitive to whether someone wants to talk about sickness or something else entirely.
As Chaplain Resident at Mayo Clinic, Natasha Dachos, LMSW, is often in conversation with people coping with illness. “The most important thing to remember,” she says, “is that this is a whole person in front of you. Whether they are a mother, a father, a child, a teacher, a person who likes to run — they are a whole person, with all the complexities that go with it.”
It’s easy, Dachos explains, to focus exclusively on the illness — losing sight of other aspects of their lives. “Sometimes they feel quite ill, and sometimes they feel less sick. But being sick is just one part of the whole person.”
Academic, medical, organizational, and work environments all have complex hierarchies. If you’re in a position of power or influence in someone’s life, it’s important to be aware of the ways the imbalance of power can shape your conversations during a time of illness.
For example, asking an employee about their diagnosis or treatment might make them feel pressured to talk about a condition they’d rather not discuss at work — even if the question is well-meaning.
What to say at work
If you’re able to speak privately, you could say something along these lines: “I know you were out for a while recently. I hope you’re OK, but if you’re not, I’m here if you need help or you’d like to talk.”
In a medical setting, healthcare providers may need to actively encourage questions from people worried about taking up too much of a caregiver’s time.
In one 2018 study, 50 to 70 percent of patients in the intensive care unit wouldn’t speak up about their concerns out of fear their caregivers would consider them a troublemaker. Gender, age, race, and economic status can make it even more important to listen with care, speak sensitively, and respect boundaries.
If you’re having conversations with a long-time friend, power differentials probably won’t be a big factor in your conversations. But if your friend has developed a condition that’s considered a disability, if medical expenses have changed their economic position, or if they have an illness that’s often stigmatized, the dynamics of your friendship may have shifted a little.
If you’re communicating by email or text, be prepared for a delayed response. If someone wants to respond honestly to your message, they may need to wait for a time when they can answer fully.
Give them permission not to reply right away
It might be kind to say, “I just wanted to let you know I’m thinking about you. You don’t have to respond!”
By the same token, it might be wise to reach out to someone who’s sick when you have plenty of time to focus attentively on the conversation.
Both of you deserve ample time to share, to process, and to respond without rushing. Setting aside a distraction-free time to talk could make the experience much more gratifying for both of you.
If you’re talking to someone you know very well, you’re probably aware of their cultural background, personal beliefs, and faith tradition. If you’re not certain, it might not be wise to assume that someone else would be encouraged or comforted by the same ideas that inspire you.
Rev. Caila Rinker, MDiv, a chaplain in Mayo Clinic’s Department of Spiritual Care, is often called upon to support people of different cultures and faith traditions. She maintains what she calls “a posture of compassionate curiosity.”
In conversations with people who are sick, there’s a unique opportunity to wonder about and discuss what’s important to people, what makes them feel stronger or more peaceful.
Dachos agrees. “Be curious about what is meaningful to that person, what gives them purpose or allows connection. Be curious about whatever comes up in the moment.”
It’s also important to understand that someone’s personality, family background, and culture may influence how open they are to discussing their illness with you. Finding other ways to offer support may be easier to accept for people who don’t feel comfortable conversing about their health concerns.
In fact, practical support offered by family and friends is critical to better health outcomes for people dealing with chronic illnesses,
Over the course of an illness, especially one with a long recovery period or a chronic condition, someone who’s sick is going to go through a wide range of emotions and states of mind. Each time you show up for a conversation, it could be a totally different kind of experience.
“Maybe you’re going to be with a friend who was really angry last time you were together. Anger is often a big part of illness,” Dachos points out.
“People may be angry that they’re sick, or angry that their bodies are diminishing, or angry that they can no longer do something that’s important to them. You may be a very safe target for that anger.”
See if you can remain open to what your friend or family member is feeling right now. If you can provide a safe space for someone to be open and authentic, you’ll have given them a gift of enormous value.
Nobody knows exactly what to say 100 percent of the time, especially in situations that are fraught with emotion for everyone involved.
“The primary barrier in having good conversations about illness is that most of us feel anxious talking about uncomfortable things,” Rinker says.
“Many people experiencing illness feel isolated or misunderstood because it is hard for the people around them to engage with their true experience. You don’t need to say all the right things, just the willingness to listen and hold space for someone’s experience will speak volumes.”
It’s perfectly OK to say, “I don’t know what to say. But you matter to me, and I’m here for the duration.”
And if you do say the wrong thing? Own your mistake, apologize, and start over. In Dachos’s experience, it can be a powerful thing to say, “I think I said something that made you shut down. I’m sorry. Can we go back?”
You’re learning how to talk to a friend, family member, or colleague who’s sick. Be as gentle with yourself as you’re trying to be with the person who’s ill.
Listening is both an art and a skill — and it’s one that few people have been taught. Like any other skill, listening can be practiced deliberately. When it’s done well, it can be life-changing.
In medical settings, listening can alter health outcomes. In personal relationships, listening can lower stress and make people feel confident and supported.
Hearing isn’t the same thing as listening. “Listening is more than hearing sounds,” Dachos says.
“We can listen with our eyes. So much of communication is about body language. We can also listen with our hearts, which is about the way you pick up on communication that is happening on many levels.”
Ask clarifying questions
If something isn’t clear to you, it’s OK to ask someone to say more about it. Rinker advises people to practice rephrasing what they hear others saying.
“It sounds silly, but when you do this, it helps people know that they are heard and understood. Even further, hearing their own thoughts repeated helps people process and get clarity and insight about their experience,” she says.
Part of the experience of listening is that you may have an emotional response yourself. Instead of assuming that someone else is feeling what you’re feeling, you can ask.
Remove the barriers
Communication experts recommend that you eliminate distractions and obstacles to listening. That includes sitting or standing so you’re both at eye level, facing each other, with no furniture between you.
If you have trouble resisting your phone’s pings, it might be wise to turn down its volume temporarily.
Those are ideal conditions, and of course, life is rarely ideal. Good conversations can be had while you’re driving to a doctor’s appointment, while you’re up to your elbows in suds at the kitchen sink, or — as we have all discovered recently — staring into your laptop camera in a video conference.
The key is to devote your attention to the person you wish to support.
Resist the urge to interrupt
If you’re talking with someone who’s been sick for a while, they may be accustomed to being interrupted.
If you’re tempted to talk over someone else, be aware that being treated for a health condition can be a disempowering experience. Being interrupted may worsen any feelings of being invisible or powerless.
A big impediment to listening is the tendency to become preoccupied about what you’re going to say in response. If you’re busy thinking about what to say next, you’re probably not listening carefully to what someone else is really saying.
“This happens all the time, in all kinds of settings. We’re only partially listening,” Dachos says.
“It might be better if we could fully listen and trust that when it’s time to speak, we can be authentic and speak from what we’ve just heard.”
Some communication efforts do more harm than good. Here are a few you should try to avoid in conversations with people you care about:
Clichés like “Everything’s going to be all right” or “Everything happens for a reason” usually aren’t helpful. In fact, they can be downright infuriating.
They may have the effect of silencing people, and they’re often rooted in the speaker’s discomfort with the topic of illness.
When someone who’s sick talks about their experiences, it could bring up memories of similar experiences you’ve had. Resist the impulse to interject your story right away.
“It’s natural for us to want to talk about the common experience,” Dachos explains.
“Someone might say, ‘Yesterday, I had an MRI,’ and right away I’m thinking, I’ve had an MRI. I know exactly what that feels like. But our stories are a reference point for empathy, and that’s it. When those thoughts come up, instead of talking about your experience, notice the thoughts and refocus on what your friend needs to talk about.”
People who are sick are often peppered with well-intentioned advice about treatments and lifestyle choices.
It’s not uncommon to question people who are sick about what they might have done to prevent an illness.
Commenting on the connection between illness and lifestyle (such as the relationship between smoking and heart disease, for example) might have something to do with a need to reassure yourself that you’re less vulnerable than the person who’s sick.
It isn’t likely to benefit someone who’s probably already aware and may be feeling enough shame or remorse as it is.
A positive outlook has numerous health benefits, but it’s important to be sensitive to when and how to encourage positive thinking.
“It’s tricky, because positivity can be incredibly powerful, but jumping to being positive at the wrong time has the unintended effect of minimizing a person’s legitimate pain or worry,” Rinker says.
“It’s important to say, not everyone is able to connect with joy, gratitude, or mindfulness, and that’s OK. Sometimes things are really terrible.”
The most important thing to know about end of life conversations is simply that you need to have them, and soon.
“If we are willing to consider that our lives will not last forever and begin conversations when we are not in crisis, things go much more smoothly,” Rinker says. “Talk about it. These conversations will be a bigger gift than you can imagine.”
And if there’s someone in your life who’s in palliative care or in hospice care, know that you can keep on having conversations.
“It’s important to remember that a person who’s sick is still here, right up until the point of death, and depending on your faith tradition, maybe even after that,” Dachos encourages.
“No matter how many machines they are hooked up to, people can hear you. Hearing is one of the last senses [to remain at the end of life]. No matter what conscious state a person is in, and no matter how many tubes are running in and out, keep using the present tense. Keep talking to them. Tell them you love them.”
When someone has an illness, broaching the subject can be tricky, and it can be hard to know what to say. Don’t let that stop you.
You may need to brush up on your listening skills or educate yourself about power differentials and cultural differences, but those are investments you won’t regret. Keep in mind that you’re speaking to a person, not a diagnosis, and be alert to changes in how someone feels from day to day.
Set aside plenty of time so you can listen to all your friend or family member needs to share — and be on the lookout for what’s unspoken. Your conversations will be healthier if you can avoid piling on advice or blame.
And for goodness sake, be gentle with yourself. Give yourself time to learn how to communicate and listen well, and get help for yourself if you need it.
“We can all educate ourselves about these things,” Dachos reminds us. “The less afraid we are, the more open we can be, and the more we can be there for other people.”