Some in the family are able to absorb the impact of diagnosis sooner than others. This can create clashing needs as some wish to talk and some need to be private and introspective.
Verbal and nonverbal clues help determine when is a good time to discuss the illness and how each will learn to live with it.
If family members cannot help each other, other emotional support systems are available in the form of groups or professional counselors.
The person with cancer has the primary right to set the timetable for when he or she is ready to talk. Others can encourage that readiness through their love and continued presence.
Talking may include expressing anger, fear and inner confusion.
False cheerinessthe “everything will be all right” routine-denies the person with cancer the opportunity to discuss fears and anxieties.
Emphasizing the uniqueness of each person, positive test results or good response to treatment is true support, both valid and valuable.
The person with cancer needs family or friends as a constant in a changing world. “I’m here,” offers great reserves of support.
Sometimes, the whole family suspects the truth before the diagnosis is made. Someone recognizes the symptoms, or the family doctor seems overly concerned. Nonetheless, hearing those words-tumor … cancer … leukemiawe are stunned as we never may have been in our lives. It is often impossible to take in the diagnosis immediately. We hear it, but somehow we don’t believe it. This is normal. People’s minds have a wonderful capacity for absorbing information only as they are ready to accept it.
All of us may not operate on the same emotional timetable. One of the family might feel the need to talk about the cancer before the others come to grips with it. Each of us has to decide when we are ready to talk; none should feel forced to do so.
This sometimes creates clashing needssome need to talk; others need to be private and introspective or even to shut the whole subject out of their minds for a while. The desire to respect privacy may be pitted against an equal need to get the whole thing out in the open.
In some families everyone becomes overly considerate of everyone else’s needs for time to adjust. Instead of meeting anyone’s needs, everyone avoids one another, building walls just when they ought to be opening doors to communication.
It is important to let the person who has cancer call the signals for when it’s time to talk. But, it is always helpful to look for clues to determine when might be a good time to discuss the cancer and how to live with it.
Signs such as apparently idle conversation, more time than usual spent with other family members, or even unusual nervousness might indicate that a person wants to talk but doesn’t know where to begin. Yet, facing cancer together makes it easier. It eliminates the need for pretense when there are so many important matters to get on with. As you talk, you should try to be sensitive to what family members or friends say,, how they position their bodies, and whether or not they make eye contact. These clues suggest whether the conversation is serving a purpose or driving someone you care about into hiding.
Some people cannot adjust their feelings and cannot help each other. Not all families can be open and sharing, and a crisis is a difficult time to be adjusting family patterns. Nonetheless, the situation may not eliminate the need to air feelings. This is the time to turn to one of several sources outside the family for emotional support. These are described in the chapter “When You Need Assistance.”
Consider Your Needs
When cancer is first diagnosed, some people can absorb only the most basic information, and even that might need to be repeated. That’s normal. We each have the right to digest information and to determine when we are ready for more, when we are ready to talk about what we know or want to know.
If others in the family want to talk about cancer before you are ready, try to postpone the discussion without rejecting the person.
“I appreciate your concern but not yet. I can’t talk yet,” for example, suggests that the day will come when you will be ready to talk. Taking care of your own needs, which are great, while trying to recognize the fears and anxieties of those you love is not easy, it’s true.
The period right after diagnosis is often a time of anger, fear and inner confusion. You might need to sort out conflicting emotions before you can express them. Or, you might find yourself lashing out, wishing to find a target for anger and frustration. Often it is those closest who bear the brunt of these outbursts. You don’t want to hurt them, but you may be angry that they will live and you might die. Perhaps you assume that they will understand and endure the rage.
Family members have feelings, too. They may lash back, expressing their own anger and hurt at your outbursts, at the possibility of losing you, at the burden of new responsibilities or at their powerlessness to change the reality of the disease. As you express your own feelings, try to remember that others need the same release.
The Family Adjusts
The period following diagnosis is a difficult time of adjustment for family members. Each has to deal with individual feelings, while trying to be sensitive to those of the person who has cancer. Being part of the family doesn’t mean you can make people talk about their feelings before they are ready, but you need outlets, too. There are ways to encourage openness. Be ready to listen when others are ready to talk, and let your continued presence show your support. But re-member, the person with cancer gets to set the timetable.
If the decision is to talk, you may find yourself the target for a lot of anger and frustration. It is easier to tel/ yourself that you are not the cause of this hostility than it is to accept this. You know you should respond with patience and compassion, but sometimes you answer anger with anger. Even these exchanges can have value if every-one learns through them to share feelings.
The opposite of anger may be false cheer. In trying to bolster the person with cancer, you may actually cut off his or her attempts to express feelings. Remember that lifting the spirit doesn’t mean hiding from the truth. Sensing despondency, some people rush in with assurances that “everything will be all right.” But everything is not “all right.” If you insist it is, you deny the reality of the patient’s world. In response, he or she may withdraw, feeling deserted and left to face an uncertain world alone. Without meaning to, you’ve abandoned the one you hoped to help and set up patterns that can be difficult to change just when support is so important. Although the cancer may be controlled, the gulf between you may endure.
It may help the one with cancer to know that you share the same fears and anxieties about the uncertainty of the future. People who honestly share these feelings find they can hold them to the light, better accept that the future may be questionable, and turn more readily to fulfilling the present. This is a very difficult period, but if you can share the difficulties, you will find there are more good days to enjoy together. And you are less likely to be devastated by truly difficult ones.
There are ways to find hope during periods of despondency or despair. We all need to remember the individuality of each case. We tend to get caught up in statistics and averages, but no two cancers ever behave exactly the same way. Each individual has different genes and an immune system, a distinctive will to live and an urge to fight. These cannot be measured on charts or graphs. No one can offer any of us “forever,” but there are good prognoses; with an increasing number of cancers, the outlook is good for a lifetime free of disease. You can look to promising test results and to treatments that have been effective in many people before. Even if the future is guarded, there may be another remission, good days, comfortable nights and shared experiences. These are real beyond any statistics. The enjoyment of life’s gifts constitutes living, not the number of days we are given in which to enjoy them.
There are safeguards against hopelessness even if there is no real cause for hope. You can still provide reassurance of continuing love and comfort. At times, “I’m here” may be the two most supportive words you can say.
Listening, Sharing, Being Yourself
There are different ways in which you can be important as a family member or friend. You can listen to expressions of feeling or act as a sounding board for a discussion of future plans. You can help focus anger or anxiety by helping to explore the specific causesdrug reactions, the job situation, finances and so forth. This may be what is neededsomeone to listen, to react and absorb the patient’s outpourings, not necessarily to “do” anything. It is a difficult role, but it can be immensely rewarding.
There is a more passive but equally difficult role. Some cancer patients view theirs as a private battle to be fought alone with only their physicians as allies, and they prefer to fight their emotional battles alone as well. But they need family and friends for silent sup-port, as respite, shelter or an island of normality. It can be draining to provide “safe harbor” from a day in the clinic or nights of sleepless panic. It can be a struggle to be forced to plan an evening out, to ask friends in or simply to stand by with wordless support. However, there may be times when this is what is needed most.
Many people think they don’t know “how to act” with people with cancer. The best you can offer is to be natural, to be yourself. Let your intuition guide you. Do what you comfortably can do; don’t try to be someone you are not. This in itself is comforting. Dealing with cancer entails enough mystifying changes without having to adapt to a new you.