Cancer & Friendship
By Helen Epstein

Long before I was diagnosed with cancer, a psychiatrist friend sent me a graph that I dimly remembered from calculus class. It had two axes: x and y. It was designed to chart friendship with x=Value and y=Maintenance. For example, a “Low Value/Low Maintenance” friend was not very rewarding but did not require much investment. “High Value/High Maintenance” required a lot of work but was worth it. “Low Value/High Maintenance” meant dump the friend. “High Value/Low Maintenance” was ideal.

Plotting this graph was crass, I thought. Friendships were gifts; they should not be analyzed. I was born into a small family – no grandparents, uncles, aunts or cousins -- and friends have always played an important role in my life. As a Brownie Scout I sang about making new ones but holding on to the old: one is silver and the other gold. I still believed that. My friendships have survived marriages and divorces, long distances, political differences and several varieties of addiction. I have rarely given one up easily.

Until cancer.

Illness taught me a lot about being a friend. I noticed how I changed dramatically: undergoing a long course of surgery, then chemo, then radiation, I became too weak to be my energetic, extroverted self. I lay on a chaise longue for much of the time, unable to entertain – I couldn’t even talk for more than a few minutes at a time. On the advice of cancer veterans, I put together an email specifying my needs to friends: Some of you have asked how you can help. Please hold your questions and advice for the time being. Please send recommendations of your favorite movies and mini-series. For those within driving distance, please bake or cook something. Patrick does not cook and I will have trouble shopping and/or organizing meals and he will need help.

Some were familiar with cancer and knew exactly what to do. Others had no clue. A couple whom I thought flaky became practical. Some stepped up. Others disappeared from view.

I did perform friendship triage. I stopped seeing friends who couldn’t help; I identified those who did. By the time chemo kicked in, I had no slack to cut anyone, no resources to humor or console or excuse. I am the eldest daughter of my family, maternal, empathic and helpful. I had always been a reliable support person, but I had lost the capacity. I began to become aware of people who sapped my energy in any way and I stopped seeing them.

The novelist Henry James once advised writers to be people “on whom nothing is lost.” I was a journalist, accustomed to listening and observing, but for what seemed the first time in my life, I was forced to be completely passive and quiet. Instead of talking, I listened. There were so many ways people required my attention I realized. Intellectually. Emotionally. Others whose values had long disturbed me and on whom I expended energy suppressing my feelings. Instead of spending that energy, I began to be aware of taking it in. I noticed that my most thoughtful friends paid attention to what I told them I wanted: short talks and visits; good news, good food, good company, no advice, no questions, chocolate. 

Happily, most of my people came through. My brothers and sisters-in-law actually became closer to me than they had been before I was ill. Old classmates with whom I hadn’t been close in high school came through for me, shared their experiences and were so funny and helpful that I wondered why we hadn’t been besties back then. Good friends emailed regularly, recommended music, books, movies and livestreams. Those who lived within driving distance kept on bringing homemade food, even if they were themselves ill or had sick partners, difficult work or children with special needs.

Those parents of special needs adults were the most astonishing. Because of the pandemic, their adult children were home full-time. They were exhausted yet they came through for me again and again.

Other friends, however, did not. Casual acquaintances had no idea I was ill and, because I was an author, wanted to correspond or talk on the phone, to send me their manuscripts or films. This too felt like triage but I learned to play the cancer card, and reply, “I’m sure you didn’t know that I’ve been ill and cannot...” That usually ended the correspondence. But sometimes, it only encouraged more.

So sorry to hear this news, I heard back from a couple. We hope you recover quickly ... We also had a very difficult year. Our daughter died of colon cancer after fighting for 3 and a half years. Our brother Salomon, died of brain cancer last October... I was sure they meant well but their email landed like a bad news bomb.

Taking my cue from Henry James and observing my friends closely, it was not lost on me that, like romantic love, friendship is often a matter of chemistry. You can analyze the reasons: delight in another’s being, shared sensibility or sense of humor, complementary personalities, proximity, shared history – particularly school or work history. But friendships are not always subject to rational analysis and more fragile than they appear. Some people noticed that my behavior had changed. Others did not. I had no desire to explain anything, no sense of obligation to help anyone else understand what I was going through. Some people always feel this way. I never had. I noticed that I had been obliged to contract cancer in order to remember to identify what I needed and to put those needs first. Remember this when you are well, I told myself. You don’t owe anyone anything. I kept my focus narrow: eat, drink, walk, nap, breathe, sleep. Repeat.

Most people rolled with my new self. They remembered to hold their questions and advice. So many of them had been through cancer or had tended someone who had that they knew the drill. But some didn’t. So it was that I found myself reading this email:

Dearest Helen,

I have been going back and forth whether I should write to you.

It all started when we were scheduled to go over to your place with soup in hand. Then it was canceled last minute without explanation. I think what hurt my feelings was that you didn’t give an explanation as to why. You didn’t have to, but it would have been nicer. I was also willing to move on, because I knew how hard things were for you. It is also hard for me to acknowledge this, because you might think that it is so trivial…

Her husband didn’t know she was writing to me and I should not tell him. And so on. At another time, I would have responded. But I had no gas in my empathy tank. Instead, I had rage. And she was a therapist! I let her email sit.

I’m out of danger now. After a year, I’ve moved slowly back toward my more familiar role as a friend. I’m back to chattering away but I listen more and don’t pepper people with questions the way I did before cancer. I’ve learned that though I am very curious and highly interested in most people, not all welcome questions. They can feel interrogated and invaded rather than pleased by my interest. I also try to curtail giving advice unless asked. I may be very late learning these things but better late than never. I think cancer has made me a better friend.


Helen Epstein is a journalist and author who lives in Massachusetts. Her new book, Getting Through It: My Year of Cancer During Covid, is now available on Amazon.

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