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HEART Insight:
doi: 10.1097/01.HEARTI.0000285624.77631.e1
Features: Heart-To-Heart/When The Chips Are Down

Being There When You're Needed The Most

Bascom, Erin

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When a friend is diagnosed with a serious, life threatening illness, it's only natural that he or she may feel angry (“This isn't fair! Why me?”); frightened (“Is this a death sentence? What's going to happen to my children?”); and depressed (“I'm no good to anyone. I don't even want to get out of bed anymore.”)

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But what you may not know is that you may be experiencing the same emotions. And if you don't know how to handle the strong emotions that you and your friend are feeling, your friend may feel you are unsympathetic, don't understand what he or she is going through—or worst of all, abandoned by you.

People who have heart disease and other serious illnesses experience a whole range of positive and negative emotions, that can affect their behavior, says Kristin Vickers-Douglas, Ph.D., a psychologist at Mayo Clinic in Rochester, Minn. “Fear, a sense of loss of control, anger and frustration are all common in times of personal upheaval. Personality and coping style affect how someone handles stress, and serious illness often brings out personal strengths and weaknesses,” she says.

“A person who doesn't want to feel needy or dependent—not wanting anyone's ‘pity’—may deliberately become nasty to push his friends away. Someone else who feels that life isn't fair may continually compare her own misfortune and your good luck, and complain that you can't possibly know how she feels,” explains Vickers-Douglas.

“Emotions can be expressed in a variety of ways. One person who is angry about his health problems may energize himself to ‘fight back’ against the illness, while another person may take his anger out on the people around him,” says Vickers-Douglas. Similarly, “one person worried about her health may seek out all the information she can get, while another may avoid the topic altogether.”

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It Takes Two To Tango

“It's important to realize that there is no ‘right way’ to cope with illness, and that any two people will likely respond to stress and negative emotions differently. If you're angry or annoyed about how your friend is treating you as a caregiver, try to think about the emotions your friend is likely experiencing,” advises Vickers-Douglas. “Avoid taking his or her behavior too seriously, otherwise you may become so annoyed and resentful you stop all efforts to be helpful.”

After you have acknowledged and understood your friend's emotions, it's time to tackle your own feelings.

For instance, if you are anxious about a friend's health, you may inadvertently take on the role of “health cop,” explains Vickers-Douglas. “I'm going to help [by commenting] every time he lights up a cigarette.” Or, “I'm going to pay attention to what he orders at a restaurant.” You may think you're being helpful, she warns, but you can “come across as very unsupportive.” She adds that nagging will likely make your friend annoyed, ashamed and overwhelmed. If you are scared that a friend might die or are heartbroken that he or she is suffering, you may go to great lengths to avoid discussing the health issue or may even minimize the gravity of the situation, explains Vickers-Douglas. Your friend will be “less likely to feel comfortable expressing his concerns or asking for help,” she says.

Unsolicited advice is also a no-no, warns social worker and psychotherapist Susan P. Halpern, M.S.W., who has spent 11 years counseling people who have been diagnosed with serious illness. Giving someone advice he or she has not asked for sends the message, “I know more than you do.”; “I'm smart, you're stupid.”; and “I'm in charge, you're helpless,” says Halpern, author of “The Etiquette of Illness: What to Say When You Can't Find the Words” (Bloomsbury, 2004), which uses real-life stories to teach people to communicate with kindness and compassion.

Halpern's experience in maintaining friendships complicated by serious illness isn't just professional, it's personal. In 1995, Halpern was diagnosed with low-grade lymphoma. She explains it was both a very heavy thing to deal with and a kind of “kick into life.”

She adds that she had gone around “practicing for life” until 55—her age when diagnosed—and “suddenly this was going to be it, I better start living it fully.”

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At first, Halpern thought she'd go to her doctor's appointments and find out that the cancer has come back or that something terrible is happening, and that she'd just go home and get into bed.

Halpern says her friends helped her get through her bout with cancer. “More healing than any of the chemicals, drugs, and doctors [was] the underlying support of my friends. They phoned, they e-mailed, they wrote and they came to visit,” she adds.

One friend brought movies over and they watched them on the couch, and another friend paid for her to get a professional massage. Someone else gave her a box filled with goodies—soaps, lotions, a kimono, and a bracelet—and she knitted with yet another friend.

“It was an enormous lift to know I wasn't doing this alone; I was surrounded with friends and loved ones.”

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Whenever You Call Me, I'll Be There

The surest way to avoid unintentionally upsetting a friend who is sick is to have an honest discussion about the type and amount of support he or she wants from you. Vickers-Douglas suggests saying something like: “I'm really concerned about you. I'd love to be able to help in some way. Can you tell me what you think is helpful, and what's not helpful?”

“If you start by asking gentle, open-ended questions to understand your friend's comfort level with accepting support it's hard to go wrong,” says Vickers-Douglas. As time goes by, your friend's needs and preferences may change, so “keep reassessing what's helpful,” she advises.

“Think about what [you] would want for [yourself] from that friend, because what we do for the relationship grows out of context. So, I would do one thing for one person, but another for someone else,” Halpern advises. She adds that she might send one friend a plant, but visit another daily or weekly. “Doing too much can be as burdensome as doing too little.”

If your friend isn't quite sure what he or she needs from you, or doesn't feel comfortable about asking for or accepting help, Vickers-Douglas says it's okay to be proactive by offering specific ideas or suggestions. For example, “How about I bring over dinner tomorrow night?” or “Would you be free to go for a walk at 7?”

Some final advice: “I really encourage people not to do what they can't do. We should not bend ourselves out of shape for each other—we [should] do what comes naturally to us,” says Halpern. Adds Vickers-Douglas, “Caregiving is a drain emotionally and physically. Make sure you take time for yourself—and ask others for help, if you need it—so that you can recharge your own batteries.” HI

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Friends In Need, Friends In Deed

When Debbie Tillis, 62, and Sylvia Rackow, 75, first met in an elevator at a 2002 symposium on women and heart disease in Rochester, Minn., they found they had much more in common than heart disease.

They immediately started yakking away, and discovered they were both from New York—Rackow lived in Manhattan, and Tillis lived just across the East River in Queens. After they returned home, their friendship blossomed. Over the years, they helped each other through several illnesses—cancer, diabetes, and, of course, heart disease.

“You know how a certain person comes along that you really gel with, and it's very unusual having that kind of friendship,” says Tillis. “It was just absolute fate—she just took me by the hand, and we just went from then on.”

“Debbie had just lost her mother. She had been close with her mother and I knew what she was going through, because I had lost my mother about five years earlier and I had been close with my mother, too,” explains Rackow. “We bonded right away, and since that time we've been sisters.”

Before Tillis met Rackow she felt alone. Her family tried to be understanding, but she didn't feel they could relate to the depression and anxiety patients with heart disease typically experience. “I was a mess. I was on every antidepressant you can think of. I was a walking zombie,” Tillis recalls. “It's a devastating illness. When you hear the words ‘heart attack,’ ‘bypass,’ ‘defibrillator’ or ‘heart transplant,’ you just go into another zone. Thank God I have Sylvia.”

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“She's like my big sister,” says Tillis. She adds that Rackow checks to see she's eating healthily, exercising and getting enough rest. “I'm always getting e-mails from her: ‘You must rest! Let me worry about it, I'll take care of things!’”

In 2003, the tables turned. Rackow was having trouble breathing, climbing steps and walking up hills; she was diagnosed with heart failure. Soon after, the two friends went to Scottsdale, Ariz., together to attend another seminar on women and heart disease.

“It was May, and very hot in Arizona, which is very debilitating to someone with heart failure. Debbie would hold my arm and help me up the stairs, and she'd take me back to our air conditioned room if she thought I had been out in the heat too long,” recalls Rackow.

Tillis has also helped Rackow, a type 2 diabetic, control her glucose level. “She will not let me have cookies or junk food,” says Rackow. “I've only been a diabetic for five years,” she adds, “and I still am tempted to eat things that aren't good for me, so it helps when she reminds me that I shouldn't be eating something.”

About a year ago, Tillis needed to lean on Rackow again, after being diagnosed with another serious illness. Tillis says, “I didn't need to join a support group, because I had Sylvia.”

Erin Bascom

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Top 10 Things You Can Do To Help a Sick Friend Feel Better

1. Listen.

2. Give your friend a hug.

3. Rent a movie, and watch it together.

4. Run errands.

5. Accompany your friend to doctor's appointments or treatments.

6. Give your friend a gift card from a nearby bookstore, or a subscription to a magazine on a subject of interest to him or her.

7. Bring a meal over and then leave, in case your friend isn't up to eating at the table.

8. Give your friend “alone time” by babysitting or offering to take the kids when your family goes on an outing.

9. Send funny cartoons, jokes—or even just a quick note to say “Hi”—by e-mail or snail mail.

10. Pamper your friend with flowers, a goody basket brimming with spa-quality lotions and potions, or a professional massage.

© 2007 American Heart Association, Inc.