Annabelle Gurwitch is an actress and the author of six memoirs. Her latest is “The End of My Life Is Killing Me,” from which this essay is adapted.
“Are you sure you have cancer? You don’t have the cancer look.”
After my out-of-the-blue diagnosis of stage 4 lung cancer, I got stupefying comments of this sort, or the more colloquial “You don’t look cancery,” from even my most well-intentioned friends. They were mistaking the effects of some treatments for symptoms of the disease itself. “I’m sorry I don’t look sick enough for you,” I took to responding, which turns out to be a reliable conversation stopper and an effective way to alienate your loved ones.
Friends and even distant connections sent me cozy throws, cushy bathrobes, and fuzzy slippers, anticipating that I would be undergoing a grueling regimen of chemo and radiation. These went unused because I turned out to be eligible for a one-pill-a-day targeted therapy with few side effects. This precision medication has provided a temporary reprieve — it doesn’t offer a cure; it delays progression — and an astonishing quality of life.
My full head of hair and normal weight were a continuing source of confusion. That complicated the dynamics in my support network.
When my friends and neighbors had experienced medical crises, I’d signed up for meal trains, accompanied them to doctor’s appointments, visited during hospital stays. People offered to do that for me, but I didn’t need assistance getting that one pill a day into my mouth. Words become the most important and only offerings available, but even a casual remark could cling like the smell of spoiled milk, seeping into the cracks of the second skin I’d slipped on to survive.
The most maddening well-meaning sentiment I heard was, “None of us knows what’s ahead; I could get hit by a bus tomorrow.” My rote response was, “You do know, along with having cancer, I could also get hit by a bus, so it’s like I could double-die.” That was not something anyone wanted to hear.
As someone facing lifelong treatment, I assumed the role of not just disease manager and forensic medical billing accountant but of grief counselor for my loved ones mourning my impending demise. “I got this,” I repeated, adopting a performative indefatigability.
My friends and family tried to bolster my resolve, and I managed to pick fights with almost all of them. When we talked, if someone sounded upbeat, I’d mention the statistical likelihood of impending death. If someone sounded negative, I’d feel compelled to be positive.
It was my sister who rescued us from the morass of communication quicksand with the 3H strategy. She can’t remember where she read about it, but, essentially, when you’re in conversation with someone dealing with formidable challenges, don’t rush in with solutions or advice. Instead, ask: Would you prefer to be hugged, helped, or just heard? It’s such a simple tool, but it isn’t always the first response that occurs when someone is suffering.
I learned this firsthand when I began mentoring other patients. One of them, let’s call her S., expressed frustration with her care. Like me, her health was being held stable with a targeted therapy, but she wanted to go for a cure. My gentle, and oft-repeated, suggestion that she consider being satisfied with her current regimen, which is the standard protocol for her condition, did not go over well. Asking if she wanted a hug seemed an overstep, so I decided to take her response as a request to be “just heard.” So I listened when she described how her second second-opinion consultation hadn’t produced new insights. I listened when she made an appointment for a fourth opinion, and by then, I’d made the mental leap from certainty to curiosity. When S.’s fourth doctor affirmed the wisdom of staying the course, the news was disappointing to S., but it also relieved her anxiety in a way I wasn’t able to achieve. A 3H strategy win.
All happy patients are alike; each unhappy patient is unhappy in their own way. We can’t know what’s going to provide solace, and that’s the pristine utility of the 3Hs, the invitation to listen more and talk less.
At a community support summit for cancer patients, I took a poll. “None of us knows what’s ahead; I could get hit by a bus tomorrow” overwhelmingly topped the group’s list of ministrations guaranteed to enrage. And which of the 3Hs provided the most comfort? In descending order: heard, hugged, helped.
My sister and I employ the 3Hs now with almost comical frequency. The other day, I happened to phone when she was stuck in an elevator. “Would you like to be helped, hugged, or heard?” I asked, which, in fact, provided a much needed moment of levity as she awaited rescue.
What of that other H that is often bandied about in such circumstances — hope? Recently, I hit a milestone: five years on my first line of treatment. The innovative medication eventually loses its effectiveness, but the timeline varies. Some patients see no response, and the average response lasts for 18 months, so I’m an outlier and in all likelihood on the downside of the effectiveness bell curve. Hope that I might squeeze out just a bit more time and that the next line of treatment won’t have more deleterious side effects seems an essential but elusive companion to this next phase of my journey (although I am deathly allergic to the phrase “cancer journey”). So why didn’t whoever codified the 3H mnemonic include the fourth H? Was it that “hopes and prayers” are proffered to the point of ubiquity and are almost meaningless? Or did they intuit that when friends invoke hope, it can seem too much like “the thing with feathers,” in the way that the hummingbirds that frequent my bougainvillea make fleeting visitations, hovering, and then vanishing without a trace?
Perhaps this wise person realized that hope isn’t something our loved ones truly can offer. I welcome being hugged, heard, and helped by the people in my support network, but if “cancer has been a teacher” (another phrase that no one with cancer wants to hear), I have learned that my most reliable source of hope is peer-reviewed science. Although, truth be told, in 2024, when I was diagnosed with a second cancer and needed a lumpectomy (yes, you can acquire a second cancer while in treatment for the first) I had a surgeon who was a hugger, and it was really nice.