Rule #1:
Consider carefully before asking, “How are you?”

We all do it. It’s actually one of the few shreds remaining of what used to be called “etiquette.” We all ask the question, and when we are asked we mostly answer, “Fine.” It’s just a social convention.

But when someone is in the throes of an illness that causes fatigue, nausea, fever, chills, soaking sweats, deep pain, and/or death — and that’s just the illness; never mind what the treatments do — well, to say the least, it makes for an awkward conversational opener.

The sick person can go with social convention and just say, “Fine,” but you’ll both know it’s a lie: problematic at best. Or he/she could tell you how she/he really is, but that will inevitably be a complex answer that makes you both late for your next appointment. And let’s face it, you didn’t really want to know, did you? The question slipped out before you thought it through.

Rule #2:
Do not underestimate the nobility and wisdom
of minding your own beeswax.

Unless you are the physician of record, keep your goddamn medical opinions to yourself. It is not your job to determine what, if any, treatments are appropriate. Especially when said treatments are painful, debilitating, and expensive, and the other choice is pushing up daisies, kindly remember that it is not your life on the line. Even if you feel absolutely sure you would make this or that choice were you in the patient’s shoes, those are in fact the patient’s feet in there, not yours. You don’t know what you would do. Nobody does.

Please do not insist that you know, or know of, a fabulous doctor the patient really should see in a city inconveniently distant from the patient’s residence, because of course the doctors in the patient’s own vicinity can’t possibly be as good as the one that a friend’s friend’s son saw for treatment.

Please do not recommend “must-see” websites.

Likewise please bite your tongue — hard — if tempted to recommend against prescribed treatments. Even if you really, really believe that everything is curable with the right herbs, vitamins, positive thoughts, acupuncture, Tesla coils, and cannabis, keep it to yourself. Save it for your own cancer treatment, should that happy occasion arise.

Rule #3:
Try listening with your mouth shut.

Avoid the temptation to tell the story of your great-uncle Fred, who had cancer and was given sixteen rounds of chemo and enough radiation to flash-fry a buffalo, yet lived to the ripe old age of 73. (He was 72 when he got diagnosed, but never mind.) You might think these survival stories are helpful/encouraging, but you shift the burden onto the sufferer to listen attentively to you.

Likewise, do not compare the patient’s circumstance with people you know or know of, who had it so much worse. Your Cousin Tilly lost not only all her hair, but her teeth, tongue, and eyeballs? It may surprise you to learn that nobody, ever, was cheered up by hearing how lucky they are not to be even sicker.

A sick person does not wish to hear about your even-worsities. Broken health is not a race to the bottom of the heap of experiences. A sick person has enough to attend to without having to nod understandingly over your tales of woe, and murmur polite nothings. That’s supposed to be your job.

Rule #4:
Avoid euphemisms.

People are generally not as stupid as we like to believe, and a person gazing into the double-barreled shotgun of life-threatening illness knows only too well what he/she is facing. Don’t avoid saying the C word thinking the shock will be too much for them to bear. Believe me, if the doctor has already phoned with biopsy results (and it is never good news when the doctor makes the call), they have already borne more reality than you can dish out.

Do not refer to debilitating illness as a “journey.” Life is a journey. A trip to Italy is a journey. Major illness is a road washout at 55 MPH in the dark with no warning signs.

Do not, puh-leeze, especially in the person’s obituary, cite his/her “courageous battle with cancer.” A person doesn’t endure the debilitating indignities of chemo/radiation/surgery because he/she is brave. A person endures these things because the only alternative is daisy-pushing—it is actually the path of least resistance. Doctors might be doing battle with cancer, but the poor patient is simply the battlefield.

Rule #5:
Don’t look on the bright side.

Screw the bright side, when a person’s life has just taken a hard left turn. Don’t say, “I hear that hair grows back better after chemo!” This is, to say the least, cold comfort.

Rule #6:
Just because you learn of someone’s misfortune,
that doesn’t make it your business.

No media postings! Ill health is personal, private, and in its strange way intimate. Please: no Facebook posts, tweets, blanket emails, or blogs. Do not initiate any Make-A-Wish or Kickstarter campaigns on behalf of the patient, without his/her express consent. Remember that you don’t own this situation, for which you may be grateful indeed.

Rule #7:
Leave your religion out of it.

Even if someone shares your faith, count on them not being cheered by the news that their extreme illness is part of God’s plan. For someone who does not share your views this comes as the penultimate, if not the ultimate, in ice-cold comfort. If cancer really is part of God’s Intelligent Design for the world, then ole God needs to go back to the drawing board. This is just not something You should inflict on Your children for whom You are supposed to have such infinite love. (Sounds more like an Abusive Father, really.)

Anyway: don’t go there. Offer to pray, if you feel so moved. But above all don’t carry on as though this wouldn’t have happened if only the patient’s faith had been stronger. And if you dare to say, “Everything happens for a reason,” you deserve a longish term in whatever Hell your religion has to offer.

Rule #8:
Thank you for offering to help.
What exactly did you offer to help with?

“Call me if there’s anything I can do” is another of those situations where you are placing the onus on the sick person: to keep track not only of whirlwind appointments, medications, side effects, and a staggering array of logistics, but now a list of people, including you, no you are not the only one, who have offered nebulous help. What, exactly, are you capable of and willing to do: Rides? Meals? Housework? Shopping? People with overcrowded brains are more likely to remember specific things, and more likely to believe you really meant it and weren’t just salving your conscience so that you will be able to say, “Well, I offered to help, but they never called me.”

Thank you for your best intentions. Thank you for not wanting to be a twit.