Cancer Journal: Hard Conversations and Deep Attention

This post is about conversations between friends where one partner has received an end-stage diagnosis. These conversations are hard for both parties.

If you are talking to a friend who is likely to die soon

You may worry that what you say will be inadequate to their situation. Moreover, people in distress sometimes react when you say something that doesn’t work for them. Here are some common examples of comments that are likely to be unhelpful, collected mostly from essays and podcasts. Only a few have been said to me.

  • “If there is anything I can do for you, just ask.” [A fine thing to say, except when it is obvious to both of us that there is nothing you can do.]
  • “I know what you are going through… and here is what I did.” [You have no idea what I am going through.]
  • “God has a plan for you.” [Well, yes. But have you, like, read the Bible? God’s plan is often a bitter path.]
  • “You are a fighter, and you can beat this disease” [Yeah, I’ve tried, and this is the result, so you’re saying I’m a loser?]

What these examples have in common is that the visiting friend is trying to solve the afflicted friend’s problems. If there is some material task that you can do for the afflicted, do it. But nothing you can say will solve their real problems. And none of us can explain why suffering pervades the world. Your job was just to call or show up, and you have done that. Showing up said more than your words ever could, which is that you value your friend and, literally, that you are there for them.

Instead, focus on listening more than talking. But how do you listen?

The shallow answer is, “the way to be a good listener is to actually listen.” This mirrors the famous quote from Dr. Francis Peabody, “the secret of the care of the patient is in caring for the patient (JAMA 1927; 88:877-882).” I don’t care for these clever responses because they trivialize the tasks. Being a good caregiver or listener is a challenge. Listening to an afflicted person is difficult because it requires you to shift your attention from yourself to your friend.

This shift is hard because you will be profoundly distressed and frightened by what is happening to your friend. Simone Weil wrote, “The sight of an afflicted man frightens away every kind of attention.”*

Simone Weil.

Of course, you want to soothe the distress of your afflicted friend. But focusing on your friend just makes you feel worse, and you begin reacting to your feelings, not theirs. Good listening requires you to be strong and be there for them, not for you.

Luckily, control of attention isn’t just a matter of will. There are specific behaviours you can practice (for example, maintaining eye contact). There’s a lot written on this; I strongly recommend Kate Murphy’s You’re Not Listening.

If you are the person facing an end-stage diagnosis

Few of you are this person right now, but many of you will be someday. These conversations will be difficult for you too, for obvious reasons. You will be sick, in pain, and frightened by death. People will say clumsy, annoying things, and you may not have the resources to respond gracefully.

If people make mistakes in talking to you, be gentle. They did the important thing: they showed up. My view: Nothing that a friend can say to me is wrong.

Just as I urged the visiting friend to attend to and listen to the afflicted person, I suggest that the afflicted person do likewise. Your visiting friend is suffering. Those who love you will suffer your loss long after you have escaped your pain. Listen to them with as much attention as you can muster. If possible, with the deep attention that accepts the reality of what is happening to them and you.

Attending to your friend in this time communicates how much they have meant to you. Deep attention is generous. End-stage cancer is disabling; thanks be to God, I’m not there yet. However, when the time comes that I can’t act, I can still serve by just being there for others.

The point is that you do not need to do things or serve others to give your life meaning. This is because you don’t need to give your life meaning. Your life has meaning, whether you serve or not. The reason to serve others with your kindness and attention is to manifest your gratitude for the love that brought them to be with you.

That said, it is hard to shift your attention to the other person when you are in pain or fearful. The function of pain and fear is to focus your attention on a threat, and your disease is a profound threat. Find a qualified physician to help you with the pain.

Here is something that can help with the fear of dying. In an important sense, that future person who will die isn’t you; he or she is someone else. You are here now, and you are alive, just like everyone else.

How do you focus on the now? You can get there via Jesus (Matthew 6:24, KJV: “Take therefore no thought for the morrow: for the morrow shall take thought for the things of itself.”). Or you can get there by any number of Buddhist paths; my favourite being Zen Master Dogen in the Genjokoan:

To study the Buddha Way is to study the self. To study the self is to forget the self. To forget the self is to be enlightened by the 10,000 things.

Or, if you need a secular path to realize the discontinuity of your present and future selves, and you have a lot of time and energy, try Derek Parfit’s Reasons and Persons. (But don’t say I didn’t warn you.)

And enjoy this moment.

*Weil (1909-1943) was a French philosopher. This post was inspired by Robert Zaretsky’s exceptional new book, The Subversive Simone Weil: A Life in Five Ideas.

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