How to Be a Friend to a Friend Who's Sick: The Etiquette Nobody Teaches

This is a book of manners for illness, written for the people standing next to it.

Letty Cottin Pogrebin was treated for breast cancer. While she was being treated, she noticed something most patients only grumble about in private. It was how badly the people around them handled it. Friends who vanished. Friends who arrived and would not leave. Friends who said the wrong thing, clearly trying hard and meaning well.

She did what a journalist does with an irritation. She turned it into reporting. She talked to other patients in waiting rooms. She talked to people living with long-term conditions. She talked to friends and relatives on the other side of the bed. Then she built what they said into a guide.

PublicAffairs published it in April 2013. It runs to 283 pages. There is an appendix and an index at the back.

The result is not a medical book, and it does not pretend to be. It is closer to a manners guide for a situation nobody rehearses. Its core belief is stated without much hedging. Illness shows what a friendship is. And most people fail at it not because they do not care, but because they do not know the moves.

The organising unit is the situation, not the disease.

The early material comes from Pogrebin's own treatment. The diagnosis, the calls, the visits. The friends who managed it well and the friends who did not. She uses herself as the first case study, which sets the tone. She is the one being got wrong. So she is not talking down at anyone.

From there the book widens into the reporting. Patients tell her what they wished people knew. Some of it clashes with what other patients say. She leaves the clash in place rather than boil it down to a rule. One person wants company. The next wants the doorbell to stop.

The practical chapters work through the scenes everyone knows. What to say at the moment you hear. Whether to visit, when, and for how long. What to bring and what not to bring. How to talk on the phone to someone who is worn out. What to do with the friend who wants to talk about their own aunt's identical diagnosis. How to help with the errands without taking over a household. How friendships get re-drawn, and how some end.

There is also a strand on the visitor's own unease. Fear of catching something, which makes no sense here. Fear of saying something that cannot be taken back. Fear of the body in the bed. That is rare in this kind of book, and one reason it lasted.

The appendix collects resources. The index is truly useful. The book gets looked up more often than it gets read straight through.

It is strongest on scale. Almost every book about cancer is written for the patient or the main caregiver. This one is written for the third row. The colleague, the neighbour, the college friend. The person close enough to want to help and not close enough to know how.

It is also strong on being specific. "Be supportive" is useless. "Do not ask an open question about how someone is when they are lying in a hospital bed with three visitors already in the room" is usable. Pogrebin picks the second kind of sentence every time.

And it is honest about the patient's side of the bargain. She does not pretend sick people are always gracious. She does not claim every friend who backs off is a coward. Some of the failures she records are her own.

The nuts and bolts have dated. A 2013 book cannot describe the tools people now use to line up help. It does not foresee how much of the visiting and updating has moved into group chats and shared calendars. For that reason, NCI's own caregiver pages now point people toward online sign-up tools.

The world of the book is also smaller than the world of illness. It is mostly an educated, city, well-connected, American world. Its friends can take an afternoon off. Some readers have a network of two people, both working hourly shifts. They will find the advice sound and the assumptions strange.

There is a religious and cultural frame here: the Jewish tradition of visiting the sick. Some readers will find that steadying. Others will find it beside the point.

And it holds no clinical content worth leaning on. That is a feature, not a flaw. But it means the book cannot answer the question a frightened friend asks most often. That question is what the illness is going to do.

NCI treats this ring of people as a subject in its own right.

Its Support for Caregivers of Cancer Patients pages define caregiving widely. It covers help with day-to-day things such as doctor's visits or making food. It covers managing medicines, and lining up care and services. And it covers emotional support. NCI notes that people often become caregivers with no warning and no training.

The line NCI comes back to is blunt: "If you don't take care of yourself, you won't be able to take care of others." It says caregiving stress has both physical and mental effects. It lists the usual sore points. Balancing caregiving against a job. Holding several family roles at once. And the oddness of a relationship where the roles have swapped.

On asking for help, NCI's page about changes for the family is plain. Asking for help is not a sign of weakness. It suggests keeping a written list of tasks, so people who offer can pick something real off it. Pogrebin lands on the same method from the other direction.

NCI also publishes a booklet written for this audience rather than for patients. It is When Someone You Love Is Being Treated for Cancer: Support for Caregivers, last updated in March 2022. It covers the changes caregiving brings, and coping. It covers ways to ask for help and support. It covers looking after one's own body and mind. And it covers talking within the family, and handling wider family and friends.

MedlinePlus is the National Library of Medicine's patient service. It lists the plain tasks in the same flat tone. Bathing, eating, medicines, housework, cooking, errands. Driving to appointments. Company and emotional support. Arranging care, and making health and money decisions. It grants that a caregiver may be "on call" 24 hours a day.

The book's answer to loneliness is better friends. NCI's answer includes something friends cannot supply.

On cancer support groups, NCI describes meetings for people with cancer and anyone touched by the disease. It states that research shows joining one improves both quality of life and survival. It sets out three formats. In-person groups at hospitals, community centres or schools. Online groups open at any hour, which it notes matter most for people in rural areas or unable to travel. And telephone groups run as conference calls, at little or no charge, linking people across the country.

Groups differ in who they are for. Some cover all cancers. Some cover one cancer, or one age band. Some are built around a cultural or religious community. NCI notes that some groups are just for family members. Those deal with role changes, relationship changes and money worries. Its plain suggestion is to ask the health care team, and to sample more than one group before deciding.

That is the honest addition to Pogrebin's argument. Friends can be taught to visit well. They cannot be the only people a patient talks to. NCI's position is that the professional and peer routes are not a backstop for people with weak friendships.

For what the practical side looks like in detail, see practical help for caregivers. See also how to set up a meal train. For the talk itself, see how to talk to someone with cancer. For the other side of the visiting question, see saying no to unwanted visitors.

Pogrebin's rules are specific on purpose. Vague kindness is what sick people already get too much of.

It suits the friend who has just heard, is frozen, and wants a sentence to say tomorrow. It suits people who work around illness: clergy, teachers, managers. It suits reading groups, because it starts arguments.

It suits patients less well. Many read it and hand it on, which may be how it really spreads.

It does not suit anyone looking for medical facts. Nor anyone in the middle of a treatment decision. Nor anyone whose problem is that there is nobody in the second ring at all. For that last reader, the federal support-group routes matter more than the manners.

• How to Be a Friend to a Friend Who's Sick — catalogue record (Open Library)
• Jewish Book Council review of How to Be a Friend to a Friend Who's Sick
• NCI — Support for Caregivers of Cancer Patients
• NCI — When Someone You Love Is Being Treated for Cancer: Support for Caregivers
• NCI — Cancer Support Groups
• NCI — Changes for the Family
• MedlinePlus — Caregivers

This page describes a book for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care.