How to talk to people about cancer

Seventeen years ago this month Catherine was entering her 8th month of pregnancy. We’d just moved into our house at 100 Prince Street, and complicated, dusty renovations were underway. For Catherine it was a hot, uncomfortable summer, and it was my job to try to make things better.

One August night I went along to the video rental store to get a movie, thinking that would be a good distraction. I came home with a VHS tape of Angela’s Ashes, the film adaptation of Frank McCourt’s book of the same name. I thought it would be a light summer romp through Ireland.

I was wrong.

Here’s the introduction to the Spark Notes summary of the book:

The narrator, Frank McCourt, describes how his parents meet in Brooklyn, New York. After his mother, Angela, becomes pregnant with Frank, she marries Malachy, the father of her child. Angela struggles to feed her growing family of sons, while Malachy spends his wages on alcohol. Frank’s much-loved baby sister, Margaret, dies and Angela falls into depression. The McCourts decide to return to Ireland. More troubles plague the McCourts in Ireland: Angela has a miscarriage, Frank’s two younger brothers die, and Malachy continues to drink away the family’s money.

Careful readers will note that packed into that one brief paragraph is one baby death, the death of two children, and one miscarriage.

Angela’s Ashes, in other words, is not the film you want to watch while you are uncomfortably 8 months pregnant.

A few weeks later, we were over for supper at a friend’s house; sharing the table with us were a couple from Boston, old friends of our host. As the evening progressed, I took the opportunity to relate the story of my ham-handed movie curating.

One of the old friends, perhaps not understanding the larger message of my story, decided this would be a good jumping-off-point for a detailed description of every horrible thing that had ever happened to any of her parents’, grandparents’, cousins’ and in-laws’ pregnancies. “My dear old Aunt Gertie had 17 miscarriages,” she might have said (the details escape me), “including several involving packs of rabid wolves.”

I think of that night often, and I thought of it again this afternoon when I came across a pointer from Jason Kottke to 10 ways to have a better conversation, a TED talk by journalist Celeste Headlee.

Number 6 of the 10 is:

Don’t equate your experience with theirs.

In the video, Headlee elaborates:

If they’re talking about having lost a family member, don’t start talking about the time you lost a family member. If they’re talking about the trouble they’re having at work, don’t tell them about how much you hate your job. It’s not the same. It is never the same. All experiences are individual. And, more importantly, it is not about you. You don’t need to take that moment to prove how amazing you are, or how much you’ve suffered.

I am an offender in this regard as much as anyone: I’m not naturally comfortable relating to other people, and in my discomfort I’ll often reach for an “oh, X happened to you – X happened to me too!”

Sometimes this is fine: it can be a way of establishing common interests, or common struggles; often, though, I should follow Headlee’s advice, and let their X stand on its own, without a need for buttressing by my X.

Since Catherine was diagnosed with metastatic breast cancer three years ago, I’ve had a lot of uncomfortable conversations about cancer.

More than once, while accompanying Catherine to the PEI Cancer Treatment Centre for an appointment, I’ve run into someone I know in the waiting room, someone obviously there for cancer treatment for themselves or a loved one. What do I say?

Conversely, the last three years saw a gradual unflowering of the news of Catherine’s cancer through our community of friends, coworkers, acquaintances, and people we’ve never met before but who seem to know us.

I meet someone on the street who I haven’t seen in a few years; they know about Catherine’s cancer, but we’ve never talked about it. What do they say?

A couple of weekends ago the brake pad warning light came on in our Volkswagen. On Monday morning, I took the car into the shop and Dave, my mechanic, diagnosed the issue as being a stuck caliper on the left side. So while the brake pads on the right were almost brand-new, and had years worth of life in them, on the left side the pads were worn down to the thickness of a couple of quarters. Dave replaced the pads and the rotors, and the busted caliper, and by the end of the day I was on my way.

I’ve related my brake pad adventure a few times in the weeks since, and it’s never proved to be an uncomfortable conversation. None of the friends I’ve told the story to have felt compelled to tell me the story of their brake pads. Or how their father’s brake pads failed once and he plummeted to his death.

But brake pads are not cancer. Cancer is about life and death and struggle and suffering and hospitals and mystery. And talking about it seems almost necessarily uncomfortable. And so we run to conversational tropes to try to rescue ourselves from the discomfort.

Fortunately, despite the shroud of stress that surrounds talking about cancer, the 10 ways to have a better conversation are helpfully universal, and can work for cancer conversations as much as for any other:

1. Don’t multitask.
2. Don’t pontificate.
3. Use open-ended questions.
4. Go with the flow.
5. If you don’t know, say that you don’t know.
6. Don’t equate your experience with theirs.
7. Try not to repeat yourself.
8. Stay out of the weeds.
9. Listen.
10. Be brief.

Reading through that list I realize that I’m not particularly accomplished at any of them, although I’m trying. Headlee says number 9, “Listen,” is the most important, and I agree: we’re not very good at listening, most of us, especially when there is quiet to be filled up, and it’s in not listening where things often go off the rails.

Which is all to say that the way to talk to people about cancer is the way to talk to people about anything else.

Go with the flow. Ask open-ended questions. Stay out of the weeds. Listen.

Stuck?

Here’s a good place to start:

How are you?