Cancer etiquette

In the December issue of Vanity Fair, Christopher Hitchens takes up the difficult and perplexing question of what to say to someone who has cancer. Hitchens, who has Stage Four metastatic esophageal cancer, makes some sharp observations, as usual for him. He urges you not to confide the anecdotes of those who survived (or succumbed). If you ask how he is, be prepared for candor. At the same time, though, don’t make the mistake of assuming that he is ready for bluntness in return.

In his best passage, Hitchens lights into the late Randy Pausch’s Last Lecture (“so sugary that you may need an insulin shot to withstand it”). In fact, I would add a piece of advice that it doesn’t occur to him to pass along. Don’t recommend The Last Lecture to someone with cancer. Pausch’s giddiness has nothing to do with real hope, nor with preparing oneself for death. If you recommend it, your friend will conclude—correctly, as it turns out—that you are not serious about what he is going through.

Hitchens is entirely serious, of course. When people ask how he is, “I get straight to the point and say what the odds are,” he writes. “The swiftest way of doing this is to note that the thing about Stage Four is that there is no such thing as Stage Five.” Astutely, he notes that such a melancholy reflection may lead the cancer patient to become “self-centered and even solipsistic.” So the patient has responsibilities too.

I was diagnosed with Stage Four metastatic prostate cancer (Gleason score, nine) three years ago last month. So perhaps I am qualified to weigh in. While Hitchens is right that “there is no such thing as Stage Five,” it does not follow that Stage Five is inevitable. At least it has not been for me—so far.

Even so, hope is a dicey thing. And as far as I can tell, no one else can raise your hopes for you. There is no standardized method for achieving it, no universally valid argument for its reality. Despair may be a sin, as my Catholic friends told me in the first weeks after my diagnosis, but their telling me so did nothing whatever to lift me out of it. I had to find my own way out. Every man’s capacity for hope is as unique as his taste buds.

Don’t try to make hopeful sounds, then. What I found consoling was the consolation that was offered to my wife. It helped enormously to know that she and the children would not be left alone, even if I were to leave them. Similarly, I guess, it gave me steel to understand that I was important and dear to some people. Three or four of my friends were particularly good at this, dropping into my hospital room to say, “I read something today that reminded me of you,” or, “I listened to something and wondered what your reaction would be.” Only two people thought to send me books—no one sent me any movies—and even though the books they sent weren’t really to my liking, they meant a lot to me.

Then there were those who never even contacted me, including my own sister. Nothing quite makes you more aware of the nothingness that awaits you on the other side of Stage Four cancer. My advice: say anything, keep it light and trivial if need be—better lightness and triviality, in fact, than the awkward groping for profundity—but say something. If you say nothing, because you are afraid that you will not know what to say, then you are abandoning the cancer patient to his worst fears, and indulging your own self-centeredness and even solipsism at his expense.

But silence is not the worst breach of cancer etiquette. The worst, in my experience, is to suggest alternative treatments, to announce that you’ve heard, vaguely and fourth-hand, of amazing breakthroughs in treatment. For then you put the cancer patient in a terrible predicament. He longs desperately to tell you to perform an anatomically impossible sexual act upon yourself, but he must remain polite—he must think of how to protect your feelings, while you have given no thought at all to protecting his.