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What to Say to Someone Who's Very Sick

Expert advice on finding the right words, listening well and getting specific about offers of help

caregiver having a serious talk with her patient

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When talking with a friend or family member with a terminal illness, certain words or cliches can come across in a negative way.

En español | Whether you’re a family member, friend, coworker or even just an acquaintance of someone grappling with a diagnosis of a terminal illness, it can seem difficult to know what to say or do for them. Here, people who address this reality every day — whether they’re psychologists, chaplains or cancer patients — share advice on what helps, and what doesn’t.

Don’t say, “It’s going to be OK” 

It’s an automatic and well-intended response, but don’t try to reassure a friend or loved one that everything will end up just fine. “When I was diagnosed with breast cancer and well-meaning people would say that to me, I’d just stare at them and think, There’s no possible way that we know that,” says Breanna Wicker, area vice president of operations for the home health and hospice company Amedisys and herself a breast cancer survivor.

Suzanne Maxey, a former hospice nurse who is now battling an aggressive breast cancer, says don't tell someone who is ill that they’ll “beat it.” “That's ridiculous,” she says. “I've been a hospice nurse for years. The type of breast cancer I have  —  triple negative — comes back sooner or later. And I don't want to hear about your mother or close friend with stage one breast cancer who is now fine. That's not what I'm dealing with right now."

If you’re struggling for a way to say something meaningful, try the following, advises Liwanag Ojala, chief executive officer of CaringBridge, a nonprofit, online social networking site that helps family and friends communicate with and support loved ones during illness:  I wish this wasn’t happening to you.  This must be hard news for you to share.  I’m here for you.       

But do say something

"We hear all the time from CaringBridge users that the only 'wrong' thing to say is nothing at all,” says Ojala. “And that happens more often than you might think,” she adds. “Even the nicest, kindest, most loving people in the world sometimes ignore or don’t know how to face the elephant in the room. A simple ‘I love you’ or ‘I’m thinking of you’ if you’re not sure what else to say, is probably just the right touch,” stresses Ojala. If you’re really stumped about what to say, it’s OK not to address the illness directly, but “ask what you can do and to make sure the person knows you’re there and available,” says Kimberly Borzym, a chaplain at Advocate Hospice in Chicago.

Do make clear that you’ll be there for them

“So many ‘friends’ disappear when one has a terminal illness,” says Maxey. “I guess death brings the idea of their own mortality uncomfortably close.” Maxey, who now lives in Nicaragua, says her current community is a lifeline because they follow through. “A funny card or email, a meal, picking up meds or coming over one day to wash our clothes, clean our kitchen or bathroom; that all means the world,” she says. Her advice for helping someone in her position? “Don't just tell us to call if we need help. Chances are we won't ask, not wanting to be a burden. Help us without waiting to be asked. Believe me, it will be appreciated, both for the help and for the fact of not being forgotten.”

Be as specific and concrete as possible about any potential assistance. “People often say, ‘if you need anything, call me,’ but that puts the onus on the person dealing with the life-threatening disease,” says Rebecca Axline, a licensed clinical social worker at the Houston Methodist Neurological Institute. “Instead, say, ‘Can I bring a casserole by Thursday?’ or drop off a gift card for a massage or dinner at a local restaurant.”

Do be careful about saying, “I’ll pray for you”

If you both belong to the same church or synagogue, and you know religion is an important part of a friend or acquaintance’s life, that’s one thing. But “it’s a mistake to assume that someone shares your spiritual beliefs,” says Jennifer FitzPatrick, a professor of gerontology at Johns Hopkins University and author of Cruising Through Caregiving: Reducing the Stress of Caring for Your Loved One. This is particularly true if you’re not sure about their views on death and the afterlife. If you’re not sure about their religious beliefs, keep God, heaven, and other spiritual reassurances out of it.

Do try to create a semblance of normalcy

That means trying to keep someone who is sick involved in a world that doesn’t revolve around their disease. “We don’t want to just talk cancer, cancer, cancer!” says Maxey. “Boring! We want to talk about the latest Hollywood gossip, the crazy politicians, the funny reality TV shows.” Patients, too, need a break from their disease. “We want to go to lunch and shopping, but we just may not have the stamina to be out in the world for more than an hour or two,” says Maxey. So, by all means invite someone who’s sick out to dinner or to catch a showing of a new movie. Just remember to ask if you can pick them up and drive.

Do ask how they’re doing — today

The generic “How are you?” greeting can be tough for someone dealing with something like cancer. “Whenever anyone asked me that during treatment, I’d think, How much information do you really want? Because I can flood you,” says Wicker. A better approach: Ask how they’re holding up. This allows them to share as much or little about themselves as they like. If they sound less than stellar, follow up with that invitation to help, whether it’s offering to drop a meal later in the week or drive them to their chemotherapy appointment.

Do be a good listener

When having a conversation with a sick friend, it’s important that you have the mindset that you’ll sit and be present. “Ask how they are doing, and then really listen to them without pulling away, either physically or emotionally,” says Nancy Molitor, a professor of psychology at the Feinberg School of Medicine at Northwestern University in Chicago. That means making eye contact, physically leaning in toward them, and being prepared to stay focused even when you’re hearing about more detail than you might want. You should also resist the urge to begin talking if there’s a moment or more of silence. “It gives the impression that you’re nervous and anxious and feel the need to fill the void,” notes Molitor. Remember, in some situations, silence is golden. Your friend or loved one may feel comfort just being in the same room with you, knowing you are there for them.

Don’t get squirmy at the end

If someone you’re close to wants to talk about logistical end-of-life matters — funeral arrangements, health care proxies, wills and estates — let them, and offer to help if you can. “If death is imminent, it can really take weight off of that person’s shoulders, even if the idea of picking out a casket seems morbid to you,” says Molitor. “These may be things that they’re afraid to discuss with their spouse or their children because they’re worried it’s too hard for them.” But knowing they can communicate wishes to you may provide them some relief.

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