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Review: When a Friend's in Need

When someone we care about is seriously ill, we often feel uncomfortable and don’t know what to do. TONI BERNHARD says there’s good advice in How to Be a Friend to a Friend Who’s Sick.

How to Be a Friend to a Friend Who’s Sick

By Letty Cottin Pogrebin

PublicAffairs 2013; 304 pp., $24.99 (cloth)


When I became chronically ill in 2001, I thought it was my fault. I blamed myself for not recovering from what appeared to be an acute viral infection, as if not regaining my health was due to a failure of will. I’d been a practicing Buddhist for many years, but in my confusion and fear, I’d forgotten a teaching from the Buddha that I’d learned early on: the five remembrances. These are five facts that he said “ought to be often contemplated upon by everyone—whether man or woman, householder or monk”:


• I cannot avoid aging.

• I cannot avoid illness.

• I cannot avoid death.

• I cannot avoid being separated and parted from all that is

dear and beloved to me.

• The only thing I control is my actions.


Illness is a natural consequence of being in a body. And yet, in the chronic-illness community (which numbers over 130 million people in the United States alone), it’s a commonly held conviction that illness is the fault of the person who is sick. Indeed, the belief that illness is unnatural — literally, going against nature — is shared by many in the population as a whole.


This deluded thinking about illness is due in large part to cultural conditioning. We live in a society that bombards us with messages that fly in the face of the Buddha’s second remembrance. We’re repeatedly told that bodies can indeed avoid illness: Eat right and you won’t get sick. Exercise and you won’t get sick. Minimize stress and you won’t get sick. Think positively and you won’t get sick. And if you do happen to get sick, a pill can make you not sick soon enough.


One of the consequences of living in a culture that distorts the truth about inhabiting a body is that many of us feel uneasy and even fearful when a friend is ill; we don’t know what to say or what to do. In her new book, How to Be a Friend to a Friend Who’s Sick, Letty Cottin Pogrebin undertakes to teach us this skill. During treatment for breast cancer, Pogrebin discovered a “disconnect between how people treat sick people and how sick people wish to be treated.” She began gathering information from other patients and from veterans of chronic illness, asking them how they wanted their friends to talk to them, comfort them, and help them.


Drawing on their stories and her own experience, Pogrebin has written a candid, practical, and user-friendly guide that’s equal doses reportage and memoir. The book is an encyclopedia of helpful advice, mostly in the form of tips and lists of dos and don’ts. For example, here are a few of her tips for talking to friends who are sick:


• Avoid hackneyed platitudes and feel-good clichés.

• Listen to how they are; don’t tell them how they should be.

• Respond to what they say; don’t just move right along or talk about yourself.


And here are a few of her tips for visiting with a sick friend who’s housebound:

• Bring an item of interest to help get the conversation started — a newspaper clipping, a CD, a new app.

• Bring a few games or a DVD to watch together and talk about afterward.

• Arrive with a chore or two in mind you can do — cooking a meal, watering the plants, taking the dog for a walk, making some needed phone calls.


Although the book focuses on being a friend to a friend who’s sick, it can also help you be a friend to a friend who’s facing any of the first four of the Buddha’s five remembrances: aging, illness, death, or loss of a loved one. How to Be a Friend to a Friend Who’s Sick has breadth and depth. For this reason, I would recommend it to everyone.


I do have one reservation about this otherwise valuable book. From a Buddhist perspective, I would caution you not to set a behavioral standard for yourself. This can trigger negative self-judgment if you decide you didn’t say or do just the “right” thing.


The book contains so many “do” and “don’t” commandments that at times it feels as if the bar for being a good friend may be set too high to clear.


For example, Pogrebin relates how a simple “How are you?” can be terribly upsetting to a sick person if it’s not spoken in just the right tone of voice. In another section, she lists nine variables for a friend to take into account when deciding how long to stay when visiting someone in the hospital. And in the chapter titled “The Perfect Present,” she sets out a host of criteria that a friend should consider before gift giving.


The book’s many “do’s” and “don’ts” reflect Pogrebin’s view that good intentions are not enough. She writes: “Thin and permeable is the membrane between good intentions and bad behavior.” From my perspective as a Buddhist practitioner, behavior that is born of truly good intentions cannot fairly be characterized as “bad.”


So, what are good intentions? The Buddha identified three of them: kindness, compassion, and generosity. They are beneficial because speech and action that stem from them are likely to ease suffering and enhance well-being in others as well as ourselves. Speaking as a person who is sick, my friends’ intentions are more important to me than their behavior. When I consider what they’ve said or done, I ask myself, “Did they intend to be kind and compassionate? Did they intend to be generous?” If the answer is yes, then even if their words weren’t on the mark, or if they didn’t pick up a cue that they were staying too long, or if they brought me a gift I have no interest in, that’s okay with me. I’m grateful for their efforts.


If your friend is sick, being a good friend is not about using just the right words or bringing the perfect gift. It’s about speaking or acting in a way that you believe in your heart will ease your friend’s suffering and help him or her feel more at peace with life as it is. For example, in twelve years of illness, I’ve lost count of the number of times people have said to me, “But you don’t look sick!” I used to bristle at the comment and had to restrain myself from saying something rude in return. Now I recognize that their intention is to be kind and compassionate — they’re just trying to make me feel good. So I let it go.


Instead of setting a behavioral standard for being a friend to someone who is sick, try taking your cue from Pema Chödrön’s powerful teaching “Start where you are.” Don’t be surprised if that starting point is one of aversion to the whole notion of illness. That’s your cultural conditioning coming into play. If this happens, begin by acknowledging your aversion, without judgment. Recognize that due to past conditioning, you’ve never developed the skill of treating illness as a natural and normal part of life. Be aware, also, that the Buddha offered encouraging words about conditioning. He said that the mind is as soft and pliant as the balsam tree (something that modern neuroscientists are now confirming). This means that mental habits are not set in stone. The mind can be, in effect, reconditioned.


The most effective way to begin loosening the grip of conditioning is to cultivate compassion for your unease and apprehension. I recommend crafting phrases that speak directly to your suffering, then repeating them silently or softly to yourself. You might say, “It’s painful to feel uncomfortable about visiting a friend I care about so deeply” or “Sickness scares me but it’s not my fault.”


With self-compassion at your side, now set your intention to be kind, compassionate, and generous and contact your friend. You might settle ahead of time on a sentence with which to open the conversation. This can ease any suffering that might arise from stressful thoughts such as “I have no idea what to say.” Pogrebin’s book can help you decide on a good first sentence: “It’s nice to see you,” or “I’m so sorry this has happened to you,” or “Tell me how I can help.” Having broken the ice with your rehearsed greeting, simply be present for your friend and let the interaction unfold.


The Buddha suggested that the more you practice something, the easier it becomes. He said, “Whatever a person frequently thinks and ponders upon, that becomes the inclination of his mind.” I understand this to mean that every time your speech or action is motivated by a kind, compassionate, or generous intention, your inclination to behave that way is strengthened. You’re planting a behavioral seed of kindness that with mindful attention to your intentions and diligent practice can grow into a habit.


Yet keep in mind that in the fifth remembrance, the Buddha said that the only thing you control is your actions; he didn’t say you control the results of those actions. You may speak or act with the best of intentions and still not be well received. What should you do then? I recommend cultivating the evenness of temper and calmness of mind that characterize equanimity.


To do this, recognize that you can’t control how a friend might react no matter how well intentioned you are. Life is a mixed bag; sometimes you’ll succeed in your efforts and sometimes you won’t. It’s that way for everyone. Then, with forgiveness and compassion in your heart for both you and your friend, try again.


Shunryu Suzuki said that we can find perfect existence through imperfect existence. Look upon yourself as a perfectly imperfect “friend to a friend who is sick” and dive on in with a kind, compassionate, and generous intention — and with Pogrebin’s book as a guide. Then you can rest in the peace of knowing you’ve done the best you can.





From the November 2013 Shambhala Sun magazine. To see what else is in this issue, click here.

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