Dear Miss Manners...

Recently I've been diagnosed with cancer, and it seems like every whacko is using this as an opportunity to say rude and insensitive things. How can I tell them they're being mean without being mean myself?

- Pissed Off Cancer Patient
Worcester, MA

Dear Pissed Off:
There's absolutely no way to do this nicely. It's okay - you deserve some time on the proverbial soap box. Go ahead and let 'er rip, just don't tell anyone I said so.

Miss Manners

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Okay, folks. I've toyed with the idea of how exactly to tell people what NOT to say to cancer patients, because I feel like I've been a sounding board for all of these things. I nixed the idea early on because I knew I would alienate everyone who has ever said one of those things to me, and then everyone would hate me instead of feel sorry for me. As much as I don't like it when people pity me, I think I like it even less when they hate me. I think.

Then, recently, it seems like there's been a spate of articles in some of my favorite magazines and websites about what to say or, more importantly, what not to say to someone with cancer or someone who's grieving (basically, it's the same list for both people). So, I decided it might be time for me to write my own. BUT FIRST - you have to promise me that if you're reading this and you've said one of these things to me, you won't hate me or feel bad after I let loose. If there's a chance that you're not grown-up enough to let it go, then you can't keep reading. Okay? Good. Understand that (a) I like to bitch (it's what I do), and (b) if you're reading this, I probably care a lot about you, so don't hold a grudge (I won't).

Drumroll please...

1) Why aren't you going to Boston?

Very few people have said this to me, but nothing annoys me more. You are second-guessing my medical decisions, and that's not right. What makes you think you are more qualified to decide where I should be treated? Have you met my doctors? Have you reviewed my mammograms? Did you ever touch my boob? Didn't think so.

I was in the grocery store a couple of weeks back, and some woman stopped me in the bargain aisle and said, "Are you okay?"

"I'm fine." (go away, I'm thinking)

"Really?" I could see she wasn't going to give up that easy.

"Well, I'm going to be fine." Awkward pause... She didn't move. "I have stage IIB breast cancer, and my tumor is responding very well to chemotherapy." There. Go away.

"Well, I've been cancer free for 15 years now, so know that it's possible." Yeah, I know it's possible. "Where are you going, honey?"

"Worcester."

"Oh."

"It's right down the street from my house. Honestly, Boston would have to be a billion times better for me to even consider making the drive." It's true. I love my doctors and I'm at a teaching hospital, which I also love. I'm sure Boston is great, but it takes me literally 10 minutes from door to door to get to my treatment facility. It would be about an hour and a half door to door (accounting for a moderate amount of traffic) to get to Boston, and I would have to do it dozens of times over the course of my treatment. And I'm getting great care where I am!

"Well, hun, Boston is a billion times better. Mass General Hospital saved my life". At this point, she probably feared for her life once more because I was steaming. I mean, where the hell does this lady get off stopping me unsolicited in the grocery store to tell me that my doctors are inferior to the ones she had 15 years ago? I could have smacked her.

"But you're going to be fine," she quickly said.

This isn't the first time this has happened to me. So here it is... item number one... NEVER ask a cancer patient why they're not being treated at a facility that you think is superior! If you're really concerned, you may ask a leading question like "Are you happy with your doctors?" but that's it. Don't ever imply that the patient made a bad care decision if you don't know what the hell you're talking about. And don't think the patient won't notice if you try to be subtle. It's impossible.

And while we're on that topic...

2) Don't harass complete strangers. This is not the first complete stranger who has tried to give me bad advice. The first one was worse. Way worse. So bad, I promised I wouldn't blog about it, and I'm not, but it was bad.

A couple of weeks ago, Rusty and I were having ice cream and we saw an older woman who was obviously undergoing treatment for breast cancer. She had no hair, she was all decked out in pink and had pink ribbon pins everywhere. I wanted so badly to say something to her, but I bit my tongue. At that moment, I realized that when complete strangers say things to cancer patients, they're doing it because it makes themselves feel better.

I had nothing in common with this woman other than we both had probably the same toxic chemicals running through our bloodstream and the same awful disease. I just smiled at her and I helped her carry her ice cream (she had a cane and couldn't quite get it all herself). Sometimes people just want to be left alone, and it's usually when they're out in public going about their normal business. When I'm at an airport or shopping the bargain aisle or getting ice cream, don't try to talk to me about cancer.

3) [Insert platitude here.]

Whether that platitude comes in the form of an unqualified medical opinion like "I'm sure they caught it early", or a totally insincere "You'll be fine", or even the meaningless "I know lots of people who have beaten it", or my personal favorite "At least you're young"... it's insulting.

Similar to the drive-by cancer conversation (see 2), these statements are intended to make the speaker feel better, not the cancer patient. Many many many people have said these things to me, and it doesn't help. I know that these words come out when people are caught by surprise and they don't know what else to say, so I give them a pass. But it doesn't help - it just makes the cancer patient feel like their problem is insignificant or not worthy of a more personal statement.

What if they didn't catch it early? What if I won't be fine? I know other people have beaten it, but that doesn't make me feel better. And being young has a negative effect on survival statistics, believe it or not.

If you are ever in this situation, take a deep breath, and say something true and meaningful. "I can't imagine how this must feel", or "I'm so sorry" always works.

4) Let me know what I can do to help.

I struggled with this one, and Rusty (reading over my shoulder) didn't want me to write it. When I read this in one of the articles I spoke about earlier, I decided it was okay to include my take. Please don't be offended, because lots of people have said this to me and I know they meant it when they said it.

But it's true. I will never tell you what you can do to help. If you know me, you know I'm a stubborn pain in the ass. It's totally okay to ask what you can do to help, don't be surprised if you don't walk away with an answer.

One article I read said it pretty well: "Offer practical and specific support. Don’t say, 'Is there anything I can do?' or 'Call me if you need me.' Decide what you can do, and then do it." But I have an addendum: "Make sure your support is actually what the person wants and needs."

Understand that sometimes what you may want to do to help is not the thing the person needs at that time - so be careful and understand if they don't want help (remember, I'm a stubborn pain in the ass).

For example, one friend made us a frozen lasagna that we put in the oven a week later when we didn't have the time or the energy to cook. That was great. On the other hand, one of my old clients asked if she could come over and cook us a meal. Suddenly a good intention turns into me frantically cleaning my house and trying to be home in time for someone to cook me a meal that I would have preferred to cook myself under a lot less stress.

Okay, I'm off the soapbox now. I did release a bit of my inner bitch, but I really felt like I had to get some of those things out. And this is what you get for not giving me ideas for what to write about ;-) (not you, Jocelyn)

I do appreciate the warm thoughts, well wishes, and kind words that everyone has sent my way. And if I've alienated you when all you wanted to do is help, know that I'm doing okay and I'm sorry. Rusty and I enjoy being self-sufficient and doing things at our own pace, but I have no idea what I'll need after surgery. Hmm... windows washed, garden weeded, laundry folded, toilet scrubbed... just kidding. :-)