Yesterday, my dear friend Anne and I fell into the topic of what to say when you see an acquaintance or friend who has cancer. This matter requires some common sense and a dose of sensitivity. If you are lucky enough to never have been told, “You have cancer,” you will (happily) be unable to fully get the nuances of the situation.

It seems clear that the patient’s personality and temperament should drive the salutation decision, as well the how close you are with the patient.

This is not a tip. It’s a statement of fact.

Here, then, are the tips, in no universally significant order. (Note: I’m a woman, so I use the pronoun “her.” Guys, you know how to render this quirk of English grammar so it’s gender appropriate.)

Avoid commenting on the patient’s appearance.

This includes: you want her to feel better and most women want to look good, so it seems logical that complimenting her on how she looks will be well-received.

Wrong.

It’s safe to assume that usually, the in–treatment cancer patient feels like crap and therefore thinks she looks like crap, too. Her self-assessment is usually pretty accurate. Even if your opinion differs, don’t voice it. It’s like bringing up politics, religion and guessing the age of someone over 21. Don’t go there.

Admittedly, there may be some underlying logic why kind people with good intentions fall into the “Oh, you look so good!” sinkhole. My hypothesis: People assume that cancer makes a person look wasted, pasty, hollow-eyed, haggish, scrawny and often bald. (Some or none of these descriptions may be valid). Many patients do not meet that expectation. So the acquaintance, upon seeing the person, is genuinely and pleasantly surprised. This leads to the outburst, “Gee, you look great!”

Now, back to the degree of friendship factor. My beloved, but now deceased, friend Missy engaged with cancer for about seven years. We saw each other almost daily for many of those years. I had seen her across the full spectrum of her physical appearance over the long course of her treatment. When she really did look good, with her hair coming back, color in her cheek, purposeful spring in stride and some weight back on, I told her so.

When Missy was under hospice care at home, and the ability to hear was nearly her only active remaining sense, I transgressed. She was lying on a sofa in her living room. Her feet were peeking out from the edge of her cashmere throw; I noticed how beautiful they were. I mindlessly spoke my thoughts aloud. You’d have to know the depth of Missy’s personal strength and communication powers, but she managed to fix me with a glare and a facial expression that nailed me for my inane comment. It’s haunted me for the years since her death. It was a searing reminder to stay clear of appearance comments.

The Cancer Patient is not a Valiant Warrior.

This imagery runs rampant in conversation, advertising and in the general media. I am pretty sure that people who actively and purposefully use it are not cancer patients.

Yes, there are challenges and struggles and unexpected events, some arising by the hour. It’s bad enough that local beat cops are militarizing and daily life is looking more and more like a crazed online fight game. We don’t need to suffuse cancer chat with images of body armor, war strategies and survival-contest metaphors.

Patients are focused on getting better, or on improving their chances for survival. This requires inner strength, single-mindedness, the best-available medical care and immeasurable support from family and friends.

It does not require the patient to arm for battle, engage in the “fight of their lives,” or even to “win the war against cancer,” on a personal, individual level. Frankly, I want the clinical specialists and dedicated oncology researchers to win the war. I want them to fight the battle in their clinics and laboratories. I want to live but I am not going down dressed like Katniss Everdeen or Joan of Arc. (And certainly not in a sequel to “The Hunger Games” or tied to a stake.)

Telling the patient how well she’s fighting, how courageous she is, puts a subtle but tremendous burden on her. It tacitly implies that if the she doesn’t “win” e.g., survive), she has therefore failed. She’s lost the battle. A loser = you’ve lost, no matter how brave.

This squarely places a measure of responsibility or “fault” for the outcome on the patient. I didn’t fight hard enough? Wasn’t strong enough? Didn’t stare cancer down and beat it? I fought my best but still lost. The taint of failure is there.

I’m pretty sure that most people, shortly after being diagnosed, ask themselves what they did wrong. How did they bring this upon themselves? Where did they mess up along the line? A sin of omission or commission: somehow they must carry a measure of blame. The patient carries a burden of self-imposed responsibility and guilt. This attitude may not last long, the light of reason may outshine it, or it may weigh down the person’s psyche for the rest of their lives. Lay on the “You can win this battle! Keep up the fight!” – and you’ve added some heavy shit to the bag of rocks the patient is hauling.

Avoid Soulful Gazing and Sappy Sympathy.

Any cancer patient or survivor will tell you: the overly dramatic, “deeply concerned” approach is not a good one. This is especially noxious if you are not particularly close to the patient. The typical comment from the Deeply Concerned runs like this, “Oh… How ARE you? (Tone rises significantly on “are.”) “How are you FEE- EE – LING?” (Up-tone, elongated pronunciation on “feeling, accompanied with an unblinking stare.) I know a few people who consistently approach me in this way. I want to cringe. I want to run and hide before they get too close.

Yes, that is what I try to do. But what I really want to do is this.

Get close enough to see the pores on their noses and say: “I’m fine, thank you. And, how are YOU FEE-EE-LING?”

(Fellow patients: this paragraph is for you.)

If you’re alert and facing them as they advance, their body language will give you a few seconds’ warning before their oozy, drippy “caring” covers you in floral-scented slime. Here are the clues: their eyes widen, their heads tilt to the side, and they ignore Standard U.S. Practice on comfortable distance between two people in a non-intimate social situation. In your face and Caring Too Much. Remember: these are infrequently seen acquaintances, not former college roommates or close neighbors who’ve moved elsewhere. They’re not people with whom you’ve share a joint, a drink or a birthday cake.

This tip-sheet is not exhaustive. That is what the comments section is for. Write in. Weigh in. Just don’t be PC or SC. (socially correct). It’s my blog after all.