There are no rules for proper behavior, conversation or actions when there’s an advancement of a serious illness and no viable treatment options. Patients can find themselves confused when trying to communicate with family and friends about a dire prognosis and an uncertain future. This brings to mind what a friend with advanced breast cancer said to me when I asked, “How are you doing?” Her answer took me by surprise.
My friend began by telling me about her teenage daughter writing an essay for school on pop culture, using the Barbie doll as an example of female imagery. In every paragraph her daughter confessed, “I am confused.” She told her mother that writing about Barbie made her feel like her world was coming apart. My friend advised her daughter to remove the sentences about being confused.
My friend went on to tell me that her husband had done some editing of the essay and he had the impression that their daughter was really trying to say how confused her life was.
My friend, feeling the lingering side effects of chemotherapy, told me that she forgot about previously reviewing the essay and once again reminded her daughter to stop saying that she was confused.
My friend stopped talking about her daughter and confessed that she had been telling herself not to be confused. She described feeling strong one hour and weak the next but eating and drinking very little.
My friend told me that she was being flip when she shouldn’t be. When her husband asked how she was doing, she told him not to worry and that she would live through the weekend. Now, he was confused. He asked if she was being serious and wanted to know if she thought that she was going to die the following week. She said, “no” and apologized.
Then, my friend told me that she made the same comment about living through the weekend in a phone conversation with a childhood friend who was planning to travel a long distance to visit. She had to call her friend back to let her know that “cancer black humor” was getting the best of her.
My friend told me that not feeling well and not knowing what’s going to happen is a kind of living in no man’s land. I can understand why everyone in her circle of family and friends, including me, were confused and not sure what to say to her about the future. I found myself listening with a heavy heart as we sat on the living room sofa, recognizing that she had the right to answer my question any way she’d like.