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About the Book and the Author

I use the terms “they,” “she,” “he,” “loved one,” and “friend” interchangeably to help the writing flow. While all of the stories are true, I changed names, sex, age, and locations to protect everyone’s privacy.

I am a person living with cancer, Professor Emeritus at San Francisco State University, a bedside hospice volunteer for eight years, caregiver counselor for four years, and communication disorders therapist for thirty years. In 2009 I was named by the Hospice Volunteer Association “Volunteer of the Year.”

I published seven books, written numerous articles and delivered more than 100 lectures and workshops throughout the United States, Latin America, Canada, and Asia on topics including cancer, chronic illness, caregiving, and end of life issues.

Lessons for the Living: Stories of Forgiveness, Gratitude, and Courage at the End of Life, received six national and international awards and was translated into Chinese, Indonesian, and Portuguese. Leaning Into Sharp Points: Practical Guidance and Nurturing Support for Caregivers received two international awards.

ISBN: 978-0-9909970-0-9

Published by Wisdom to Practice Books

License Notes

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PART I: SHARING THE DIAGNOSIS

At least once in your life someone will say to you, I have cancer, and when these three words are spoken, you may struggle with a response. If a loved one or friend hasn’t already informed you of a cancer diagnosis, it’s just a matter of time until someone will, since every year fourteen million people worldwide learn they are living with or may die from this illness.

Twenty years ago a good friend informed me she had breast cancer. I didn’t know if I should be upbeat (telling her she would defeat it) or just hug her and say how sorry I was. I did what most people do. I said, “I’m so sorry,” a safe answer but not necessarily a helpful one. Twelve years ago it was my turn.

“You have prostate cancer,” the urologist said. “And it’s aggressive.”

I don’t remember what I said to him, but I still become nauseous thinking of his four words. I was fifty-seven then. Death was still something theoretical, something that happened to other people—people of my parent’s generation. After the initial shock, I wrestled with how to break the news to my wife and two adult children.

Throughout my life, I was an avid outdoors person and, despite the many infirmities of middle age, still viewed myself as “young”—a delusion that evaporated with the diagnosis. Images of being debilitated by cancer went through my mind as if they were previews for a horror movie. I had been self-reliant my entire life and rarely asked my family for help in doing anything. I thought back to the time when my friend told me she had breast cancer. Now, I would be saying the three words to my family.

Many of us struggle with whether we should reveal our condition. We may desire support, but our needs are tempered by concerns such as: What will he think of me? Will she still love me? Will they pity me? There’s also the realization that what we thought a distant event—our death—might be lurking around the corner. It’s not just the thought of death from cancer that weighs on us, but also the journey we know we are about to take. For some, cancer involves only minor lifestyle changes. But for others there are life and death decisions involving chemotherapy, radiation, surgery, or doing nothing. I have cancer is more than a statement of our condition. It’s an invitation into our uncertain world. In this section, I offer six suggestions for what you can do and say when you hear the words I have cancer.

1. Be Supportive and Specific

We often offer help through the use of generalities such as, “If there’s anything I can do, please call,” or “When you need something done, please let me know.” The rationale for being general is to allow our friend to contact us for a variety of needs. A patient said to me that, even though members of his family offered to help, they didn’t mention anything specific. It was always, “If you need anything, please call.” He interpreted the family’s offer as disingenuous. “If they really wanted to help,” he said, “why didn’t they offer to do things they knew I couldn’t do any more—like cooking meals and cleaning?” Whether his interpretation was correct or not, he didn’t contact them when he desperately needed help.

Instead of saying, “If there’s anything I can do to help, please call,” be more specific. For example, since you know chemotherapy causes your friend to become exhausted, you could say, “I know shopping for food may be difficult for you. I’ll pick you up tomorrow morning at 10:00 and we’ll do it together.” When a friend told me that walking after chemo was better than sitting, I said, “What time would you like me to come over after your treatment next week?”

Start with four assumptions. The first is that someone who is undergoing treatment for cancer will have side-effects that may make normal activities more difficult. Second, if the cancer is progressive, energy will suffer. Third, the more specific you are, the more likely your help will be accepted. Fourth, always err on the side of being too helpful. The worst that will happen is you’ll receive a “No thank you, but I’m grateful you asked.” Below is a partial list of practical suggestions shared with me by people who needed help and those who helped them.

1. Wash dishes

2. Do laundry and put away

3. Take out garbage and put a new bag into the bin

4. Take grocery shopping with a completed list

5. Help with technology issues because of fuzzy thinking from pain, chemo, or fatigue

6. Open anything that is difficult to open (e.g., jars, tightly sealed packages, etc.)

7. Find highly visible compartmentalized pill containers

8. Pay bills

9. Answer emails

10. Organize living space

2. Balance Hope with Reality

There is an inherent need to be hopeful when it comes to the sharper points of living. We hope terrible things will go away or end. We hope we won’t lose a loved one. We hope for so many good things, but we often don’t understand the damage to trust that unwarranted optimism creates. You may be tempted to say words such as, “Let’s hope for the best,” or to assure your friend that she “will beat it.”

The path cancer takes in its early phases is usually uncertain. You may want to be optimistic to raise spirits, but resist this normal impulse. This is a time to establish trust. I counseled a caregiver whose husband had pancreatic cancer. Since she was a nurse, she understood what her husband would be going through because of the treatment and the cancer’s progression. She was supportive from the time of the diagnosis, yet honest with him about how his life would change. He had to make difficult treatment decisions as the illness progressed, and the trust she established throughout their journey enabled him to listen and accept her recommendations.

Trust is not something that develops quickly. It requires repeated interactions where you’re asking a person to do something difficult or something they are unsure about. The time to begin establishing trust is when you hear I have cancer. Be supportive, but don’t go overboard with a too optimistic belief that everything will get better. You’ll begin establishing trust if you are figuratively and literally holding someone’s hand rather than being a cheerleader. Compassionately witnessing what they are going through will enable them to believe you’ll be there if their condition worsens.

Optimism doesn’t have to be limited to the cancer’s outcome. It can be related to day-in-day-out activities, as it was for a caregiver I counseled whose wife had stage IV uterine cancer. Optimism, for them, was limited to each day’s events. He was optimistic his wife would be over her nausea by 1:00 pm when they were scheduled to visit friends. Both were optimistic they would be able to walk in the evening before dinner. He scaled back the time references to minutes as the cancer progressed. Their days were filled with joy despite a grim prognosis.

3. Send Good Thoughts

I’ve heard from many people that the “good thoughts” of friends and loved ones meant much to them. While some of the thoughts were religious or spiritual, others were secular. The origin was of less importance than the bond the words created. Saying “My thoughts are with you,” or “I’m praying for you,” or “My heart is with you” conveys a partnership that can mean much to the person struggling to adapt to cancer. You’re saying, “We’re in this together.”

Those who were religious also took special comfort from prayers offered for them. One religious person organized a group who daily prayed for their friend. While all were located in different parts of the country, their friend with cancer felt uplifted every day when she joined them in a long distance prayer vigil.