“What’s her prognosis?”
I’ll ne “ ver forget the first time I was asked that question. It was the first of many days I would travel up and down the NJ Turnpike alone. Earlier that morning, at 5 a.m., coffee in hand, I quietly left the house and drove down to Baltimore to spend a few hours with my mom, who was recently diagnosed with cancer. By the time my kids woke up, I would almost be there. A babysitter would have already arrived to get them off to school, and the kids would assume that I was at a professional training or some sort of meeting. The children didn’t know that I was actually going down to Baltimore to visit their Bubby. They had no idea that their Bubby was undergoing chemo and was either in the hospital or at home recuperating from the intense treatments.
On that day, while running a quick errand for my mom, I bumped into a woman I hadn’t seen in several years. She was curious why I was in town, and in a moment of sheer exhaustion and emotion, and desperately needing support and a hug, I explained that my mom wasn’t well, that I had just driven in to be with her for a few hours. And then she asked the question. It would be the first of many such questions, but this first time was especially jarring.
What was her prognosis? I was too shocked to respond.
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I have since gotten over the shock and would very much like to respond. But I’m not going to share her prognosis with you. Instead, I’d like to share my own thoughts about why people actually ask this question and many similar questions, and perhaps offer concrete ways to be more sensitive to families undergoing a medical challenge.
Cancer terrifies people. It scares the living daylights out of everyone. Cancer has become so rampant and non-discriminating that every single one of us lives in fear of getting cancer or losing someone we love to cancer. And when you hear that, yet again, someone you know has been diagnosed with cancer, your own anxiety and fear completely overwhelm you, and you desperately try to make yourself feel better. You ask, “What’s the prognosis?” But what you’re really thinking is “Tell me they caught it early. Tell me she’s responding well to treatment,” and, ultimately, “Tell me she is not going to die.”
And therein lies the rub.
By asking questions, you’re actually asking the family of the patient to make you feel better, to somehow make this situation less frightening to you. Quite frankly, I never even asked my own mother what her prognosis was, and if I knew the answer, I wouldn’t share it. On this first occasion, I chose not to be upset or resentful or insulted, and I forgave this well-meaning individual for simply trying her best to respond to the news of my mom’s illness and not knowing how to be supportive.
To actually be supportive, one must put aside one’s own fears and curiosity – put aside one’s own personal agenda or needs and be compassionate toward the needs of the family in crisis.
Being compassionate means identifying the ways to accompany and be present for a family throughout their experience with illness, without giving advice or asking for any information in return. Compassionate communication, compassionate interactions, and compassionate helping are areas to be mindful of when dealing with families in pain.
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Compassionate Communication: Make statements, don’t ask questions.
The cancer diagnosis exhausts a family emotionally and physically. Simple questions, like “How are you?” or even “How is your mother?” are so complex and so emotionally charged that it’s actually confusing to try and answer them. Needing to respond casually can send someone into an emotional tailspin. The questions actually seem trite to the family in crisis: We’re not okay. We’re dealing with cancer!! Mom is hurting. She’s extremely fragile.
When a person is diagnosed, and the community finds out about the illness, the family’s private life and personal needs suddenly become very public. Acquaintances can minimize their distress by not asking any questions. When you bump into a family member or the person who is undergoing treatments, make compassionate statements like, “It’s good to see you” or “I have you on my mind” or “I think of you often; it’s so nice to see you,” or simply stand with the family member for a minute and be okay not bringing up the cancer in that moment.
If you are close to the patient or family, use texting, emails, or written letters to any of the family members and communicate in ways that don’t require a response. Don’t text questions or ask how they’re feeling or about the side effects. The cards my mother received from community friends and acquaintances were hung in the kitchen and were read and reread by all of us. They were a source of chizuk during the duration of the treatment. There was no expectation that she would write back, and that compassionate act had lasting impact.
Asking about treatment or protocols is extremely invasive. The diagnosis, the staging, the medical team, or the length of treatment are all extremely private and should never be inquired about. Comments about how the person looks can be hurtful and a painful reminder to what they may be experiencing. Never ask a choleh if you should “keep davening” for them. Compassionate communication sometimes means actually not communicating at all. Daven hard and keep davening, do chesed and mitzvos as a zechus for the choleh, but remember that this does not need to be communicated directly to the family.
If a family member confides in you regarding any medical information or his or her own feelings, respect that person’s privacy. Recognize that you were privileged to be entrusted with this information and that you need to keep it confidential. To show that you genuinely care, follow up with a text saying you are thinking of them and that you are there if they still want to talk. Be careful not to assume that all members of the extended family know of the diagnosis. Many families choose not to tell the extended family so as not to worry them. And always be careful not to ask questions or make comments in the presence of grandchildren, who may not know the full extent of what is going on.
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Compassionate Interactions: Identify family needs and be aware that they are fluid.
A good rule of thumb, is that whatever relationship you had with the patient or family in the past is what the relationship should continue to be at this time. If you had nothing to do with the choleh, now is not the time to create new friendships. Visitation can feel burdensome and exhausting to the patient and his or her family. Always ask permission to visit, whether at home or in the hospital, and always be respectful of the response. If permission is granted, it’s only for you and doesn’t include your children or spouse. Recognize that, while in the past you may have enjoyed shmoozing together, this visit needs to be shortened, even if conversation seems to be going well. Ten to fifteen minutes is likely the appropriate quantity of time to sit at bedside. The person who is sick is feeling vulnerable, maybe even nauseous, perhaps struggling with personal hygiene, and your presence, while approved prior to coming, may begin to feel burdensome in that moment. Remember, too, that cancer patients are immuno-compromised. Absolutely no one should ever visit who has a cold or has been exposed to illness.
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Compassionate Helping: Tune in to the specific needs of the family in crisis to be most helpful.
As a compassionate community, steeped in chesed, our instinct is to want to be involved and offer help. Everyone wants to feel like they are able to give to the family in crisis, and yet, families often have different needs than those the community is recognizing. The needs of each family and choleh are different, and it’s important to ask yourself whether you’re actually being there for the family or are doing the chesed for your own benefit.
Leaving small gifts, books, or reading materials at the door with a card is extremely compassionate and thoughtful. Making tzedaka donations as a zechus or calling close family friends and dropping off some baked goods there, instead of showing up at the house, are other compassionate ways to be helpful. Offering to help the adult children of the patient with a dinner or a carpool so that the child can be attentive to the parent is extremely supportive and appreciated and is an often-overlooked opportunity for chesed.
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Our Baltimore Torah community is at its finest when families face crisis and illness. The outpouring of support, consideration, and chesed lifts up those that are struggling, and highlights the best that a Jewish community has to offer. And those who have a difficult diagnosis and their families have a responsibility to the community as well. We have a responsibility to be forgiving and to be equally as compassionate toward them for well-meaning intentions. What works for one person will not be right for another, and there are few rules that apply equally to everyone. Some people really don’t know what to say or do, but they love and care for you, they are sad that you are hurting, and they want you to heal and feel well again.
As a survivor so beautifully said, “I imagined that the insensitive words that were said by those who just don’t know better are swirling in the air, and I exercise my right to change them around to what I need in that moment and to allow them to be internalized to provide me comfort.”
We are a community of rachmanim, and we would never intentionally cause pain to those who are hurting. Let’s learn from those who are suffering and those who are surviving how to confront illness with grace and dignity and how to truly be there to support them with kindness and compassion.