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When a friend gets ill, it's easy to bury ourselves in work, using that as an excuse to avoid the individual. But such situations are among the moments of our life that call for a greater commitment to work-life balance, carving out time from work, no matter how busy we are, to be with the sick friend.

The problem is not the siren call of work but our discomfort or distress over dealing with illness. "The awkwardness stems from when we're close to illness. We have a nagging feeling if it happened to them it can happen to me. That leads to a distancing, and we don't call or visit," journalist Letty Cottin Pogrebin says in an interview.

A co-founder of Ms. Magazine, she was confronted with this distancing by friends when she found out in 2009 she had cancer. Her journalistic instincts kicked in as she noticed the phenomenon, and she began researching the issue and interviewing her fellow patients, culminating in the insightful, just-published book, How To Be A Friend To A Friend Who's Sick. "I learned that illness is friendship's proving ground, the uncharted territory where one's actions may be the least sure-footed but also the most indelible," she writes in the preface.

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Our nervousness can lead us into ridiculously inappropriate comments. In her book, she cites a fellow who after telling a friend that the doctors had removed all his cancer got this far-from helpful comment: "How do they know?" Another patient recalled a visitor entering his room and declaring, "God, you look awful!" Hip replacements are common these days, but the woman whose friend called it "minor surgery" observed that "the definition of minor surgery is surgery done on someone else."

The clichés she heard in her research astonished her. Sometimes, she says, it's best to say little. "I'm so sad and upset for you I don't know what to say" might fit. Or: "I have no words."

She encourages empathy and action. "Empathy translated into action equals kindness. It's a foolproof formula; all you need is the appropriate vehicle for your best impulses and the commitment to stick it out over the long haul," she writes.

But that also requires honesty to complement your empathy, otherwise you can misread signals and in a zest to help you can overwhelm somebody who might need time and space for themselves. "From when the diagnosis comes, establish an absolute honesty policy. This gives the patient the right to say, 'I don't want any visitors today,' " she notes in the interview.

She says you should tell your friend with the illness three things at the outset:

  • “Tell me what’s helpful; and what’s not.”
  • “Tell me if you want to be alone and when you want company.”
  • “Tell me what to bring and when to leave.”

"It drives me crazy how people react. We send flowers and the room is filled with flowers, half dead. It would have been better to pay for a housekeeper so when the patient gets home it's clean," she says. Or for a spouse who has to commute to the hospital, consider a certificate for gas or parking.

"Both sides must be honest. The patient should be able to tell you what she needs: 'I may not need jellied food from a gourmet place. I may need an ice pack.' And the patient's friend should be able to say, 'I had a fight with my husband and can't come to visit,' " she says.

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She urges you to remember the power imbalance that exists, even amongst close friends, in these situations. Sure, it's nice that you rushed over from the fitness centre to see the patient, but with you in your workout clothes and the patient lying in agony with a bad hip in the bed, that may not be the best situation. She advises when visiting a bed-ridden patient not to stand over the patient; pull over a chair, and sit with them at eye level.

She points to gender differences in how we react. Men are more likely to be discomfited, and retreat, both because they are not as facile with the open, intimate conversations that might be unleashed and because the illness might signal weakness and emasculation. "Men may feel more comfortable if they can problem solve. But sometimes what people need most is for you to listen – just sit. For men, however, not to fix it is hard. They have been socialized that way," she says.

Her 10 commandments for conversing with a sick friend are:

  • Rejoice at their good news, but don’t minimize the bad news.
  • Treat your friends as you always did before they got sick but never forget their changed circumstances.
  • Avoid self-referential comments or anecdotes, like saying, “I know what that’s like” or “I understand how you feel” unless you can back up that claim.
  • Don’t assume – thinking, perhaps, the cancer got caught early – but verify.
  • Get your facts straight before you open your mouth, asking questions specific to your friend’s circumstances.
  • Help your sick friend feel useful, asking them to use their skills to help you if possible.
  • Don’t infantilize your friend, talking to them as you would a child.
  • Think twice before offering advice.
  • Allow patients who are terminally ill to set the conversational agenda.
  • Don’t pressure them to “keep up the fight” or “practice positive thinking,” since it’s cruel to imply that feeling discouraged is wrong.

Those 10 commandments will help you to be a good friend, in even the most delicate situations.

Special to The Globe and Mail

Harvey Schachter is a Battersea, Ont.-based writer specializing in management issues. He writes Monday Morning Manager and management book reviews for the print edition of Report on Business and an online work-life column Balance. E-mail Harvey Schachter

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