DIAGNOSIS

Fall, 2000: When I received the call from the hospital radiologist telling me that a biopsy had revealed a malignancy in my breast — something about "ductal carcinoma" — it was late on a Friday afternoon and I was home alone. I remember asking the voice on the other end of the line, "Does that mean I have cancer?"

"Yes, I'm afraid so."

"What do I do now?" I asked.

"Well, you'll need to find a surgeon ..."

I will never forget that brief conversation. I felt just as I had when a police officer came to the door in 1974 and told me my father was dead. I couldn't take in the words. I didn't know what to do. I hadn't expected that the abnormality on my mammogram would be anything more than a cyst. Like most of us who have gone through cancer, I couldn't have been less prepared for the news. I remember driving frantically over to my mother's house and blurting out to her, "I have cancer!"

* * *

In the beginning, when the diagnosis is announced, there is no rational thinking, no plan — just shock. In an instant, the person is thrust into an unfamiliar and frightening world.

From the time that she learns she has cancer until the day she begins treatment, your friend will be faced with major decisions. She may feel rushed to make choices and yet have trouble processing information or recognizing that she has options. She will wonder why this is happening to her. She will wonder whether she is going to die.

At this point, she will need time to absorb what is happening. She will need high-quality, up-to-date information so that she can begin to sort out her options and determine where to go from here. And more than anything, she will need support from friends and loved ones and assurance that they will be there for her throughout her experience.

There are three basic types of support: emotional, instrumental, and informational (Helgeson & Cohen, 1996). Emotional support is the verbal and nonverbal communication of caring and concern — being there, listening, empathizing, comforting. Instrumental support includes furnishing material goods or providing a service, such as transportation or housecleaning help — the practical, concrete sort of support. And informational support is the provision of information to guide or advise. Some sorts of support are more helpful at different stages than others. In general, though, emotional support is always helpful. Survey after survey bears this out.

It can be difficult just to be with someone without trying to fix things. But sometimes just being there is precisely what is needed. As you think about how best to be there for your friend, remember these words from Henri J. M. Nouwen (1974): "We feel quite uncomfortable with an invitation to enter into someone's pain before doing something about it. Still, when we honestly ask ourselves which persons in our lives mean the most to us, we often find that it is those who, instead of giving much advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a gentle and tender hand" (p. 38).

Most of the following suggestions will be helpful not only in the period just after diagnosis, but also during your friend's treatment and beyond. In general, try to remember that whatever would be helpful to a healthy person is likely to be beneficial to someone with cancer, unless it also creates additional work or pressure. And remember, little things do count. The right touch, a knowing glance, or a kind smile can do wonders.

DO ...

GET IN TOUCH WITH HER, and keep in touch. This may seem basic. But when I sat in on a support group for those with cancer — many whose journeys had been long ones, and their cancers advanced — I learned just how common it is for friends of people with cancer to disappear. For these group members, the memory of having been avoided or abandoned — perhaps years earlier — was still fresh and still stung.

Stephanie Madsen (2014), a motivational speaker and three-time cancer survivor, describes cancer as the adult version of cooties. "Getting it is not cool, and will send some around you scurrying away in search of a large tree to hide behind," she writes. And as hard as it is to understand why friends flee — it's not as though the person with cancer doesn't notice — it's a reality that some friendships do not survive the challenge.

You may be uneasy contacting her the first time after the diagnosis. This is normal. If words escape you, you might tell her that you're not quite sure what to say, but you will be with her throughout her illness. If you can't visit or live far away, send cards and notes. Actual physical cards sent through the mail are especially nice, as your friend can display them or keep them close by and look at them over and over again. You might even include a photo that she'll like. Continue to send cards and notes throughout her treatment. Many people tend to send a card only at the beginning of the illness. Don't worry if your message stays the same; a simple "I'm thinking of you" is fine. Leave a supportive voicemail message when you know she will be gone to treatment: extend your good wishes and tell her she doesn't need to call you back.

LET HER TALK. And talk, and talk, if necessary. One of my newly diagnosed friends found that talking about issues with her friends over and over again while they listened was the only way for her to clarify her thoughts. Remember: you are not there to provide medical advice or theological answers. Simply listen. In Kitchen Table Wisdom: Stories That Heal, Dr. Rachel Naomi Remen (1997) writes of the power of listening:

When we interrupt what someone is saying to let them know that we understand, we move the focus of attention to ourselves. When we listen, they know we care. Many people with cancer talk about the relief of having someone just listen.

I have even learned to respond to someone crying by just listening. In the old days I used to reach for the tissues, until I realized that passing a person a tissue may be just another way to shut them down, to take them out of their experience of sadness and grief. Now I just listen. When they have cried all they need to cry, they find me there with them.

This simple thing has not been that easy to learn. It certainly went against everything I had been taught since I was very young. I thought people listened only because they were too timid to speak or did not know the answer. A loving silence often has far more power to heal and to connect than the most well-intentioned words (p. 144).

LET YOUR FRIEND DECIDE what to talk about and with whom. Many well-intentioned friends will attempt to draw their friend out, to encourage her to disclose her deepest thoughts and fears. It is best not to force these types of conversations. Also, do not feel slighted if you offer help and she chooses to draw on others. There are plenty of tasks to go around. We all need to be needed,...