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Mike Lovett
Letty Cottin Pogrebin. Photo by Mike Lovett

How to Be a Friend to a Friend Who’s Sick, by Letty Cottin Pogrebin, PublicAffairs, 283 pages, $25

Warning: This intelligent addition to the self-help shelf may lead to thoughts of disease, loneliness and death.

Well, why not think about them? Letty Cottin Pogrebin has written a guide to sensitive behavior vis-a-vis friends who have cancer or find themselves in other situations that diminish the quality of life and then extinguish it. It gently instructs us how to face reality -- life’s inevitable slings and arrows. Including death.

If you find this topic a turn-off, please don’t stop reading. This book is actually meant for you. Chances are you know someone who has had cancer, and sadly, you probably knew someone who died of it.

To note just one example, Israeli women’s death rates from breast cancer are the sixth highest in the Organization for Economic Cooperation and Development (31.2 deaths a year per 1,000 women, compared to an average of 26 deaths per 1,000 in the 34 developed countries belonging to the OECD.) The question under discussion here is about how to behave, how to be there for friends whose situations may frighten not only them but us as well.

Why did Pogrebin take on this task? A successful New York writer-journalist who co-founded Ms. magazine, and political activist involved in issues related to both Judaism and Israel, she was diagnosed with breast cancer four years ago, at age 70. She was “lucky”; she “only” had to undergo a lumpectomy (a sort of a bite taken out of a breast that often leaves it a peculiar shape) and six weeks of daily radiation and that was it. Not only that, but she reports that she didn’t suffer from either burns or extreme exhaustion, which are common side effects of radiation. And she didnt have to have chemotherapy.

Lucky at cancer is still a deeply disturbing experience, a scary brush with mortality and an intensive course in waiting (apparently no matter the medical system you have to deal with). “Waiting is time’s carnivore,” Pogrebin notes in her precise prose. “It eats away your life.” She decided to use her visits to the Memorial Sloan Kettering Cancer Center on New York City’s Upper East Side “to interview my fellow wait-ers, who, like me, are killing time...in the hope that it won’t kill them,” she says. From these interviews, Pogrebin created her book, which she accurately describes as “a quirky amalgam of reportage, memoir and Baedeker.”

We might think we know how to behave well and don’t need lessons. But Pogrebin is very good at demonstrating how nothing can be taken for granted when dealing with vulnerable people. “O Letty, I was so sad to hear this news,” an old friend wrote her, and this apparently simple salutation made Pogrebin “reel” as if she’d been struck. “I know she would never hurt me intentionally,” Pogrebin writes, “yet…that single ‘O’ takes my breath away… It’s the archaic vocative O, now dead to modern speech but vivid in prayers, hymns and poems. The O of biblical vows and spiritual supplications… The O-shaped mouth in Edvard Munch’s painting, ‘The Scream.’ I’d never met a good O.”

Here one experiences Pogrebin’s sense of humor, as well as the tightrope we friends must walk. We have to acknowledge the situation but not overdo it. “I don’t want my illness to become my identity. I don’t want to be Cancer Girl,” she writes, reminding me of Israeli poet Dorit Weisman’s lines:

I do not want to be

a breast poet.

I want my breasts to be sound and sub rosa,

taken for granted, not written about

and certainly not by me. [My translation]

‘Type A personalities turn manic’

The first chapter is about how to talk and what not to say. “In the presence of a sick friend, fragile folks can get unhinged and Type A personalities turn manic,” Pogrebin writes.

I can testify that people say really stupid things. One person told me about my mastectomy: “You will get through it, unlike my Italian friend C., who will really suffer if she loses a breast.” Okay, I’m a person who gets on with life. But, frankly, I didn’t like the intimation that I was somehow less sensitive than another woman (to what exactly, the necessity of Italian-style sex appeal?).

Then there was the friend-of-husband who came to visit only after six months, because he “couldn’t face it.”

He would have learned from Pogrebin how to “give good visits.” Her chapter on that topic is subtitled “behaving well with the unwell, under almost any circumstances – even if you’re shy and awkward, hate hospitals, hardly know the person, and wish you could be anywhere else.” You get the picture.

Pogrebin discusses matters that might seem obvious but unfortunately aren’t (when visiting the bed-bound, don’t chew gum, don’t smell bad, don’t be morose). She discusses serious emotional issues (for example, the shame often involved in being sick) and makes surprising suggestions (waiting room book club of two, anyone?). She has suggestions if those we want to comfort are suffering from Alzheimer’s and, lest we forget, lending support to the caregivers.

In discussing the practical things that one can do, Pogrebin urges cooperation with friends of friends, building a kind of community around the friend in need. I would have thought that most of us in anonymous cities don’t live in genuine communities. But then I realized that disparate individuals can add up to a de facto group.

She also has a section on farewells and parting rituals. I belong to a breast cancer support group consisting of women who met in the neighborhood or at work or in the oncologist’s office. In 16 years, two of us have died; one sought our presence to the end. L. didn’t seem afraid of death. While she was still at home, she asked us to take her to the Talpiot promenade overlooking the Old City of Jerusalem; we had to carry her down the stairs of her building to the car and from the car to the overlook. She was happy; we made her happy. When she was dying in the hospital, she had a friend call us in one by one to say goodbye. In this case, staring straight into the sun had its rewards for us.

The other member we lost didn’t want us with her at the end; she told one of her children she thought it would be too hard for us. Perhaps. But the guilt we felt at being useless and rejected was great. Of course, it was her call to make, and this is one of Pogrebin’s points: What we do should depend on what the other person needs and wants.

In truth, the behaviors advocated in the book constitute a healthy approach to the people around us who are not yet in dire need due to illness. The book could just as easily be titled “How to Be a Friend.”

Pogrebin’s book can also be useful to those individuals undergoing a health crisis; she avoids the generalizations that plague the self-help genre. She mentions, for example, the drains (plastic bags attached to tubes connected to your body near the site of an operation) that you didn’t think about while worrying about everything else connected to cancer surgery, and how they shouldn’t stop you from leaving the house. I agree: I attended a bar mitzvah party with drains under my dress and it was the best such event I ever went to. It was five days after the operation, and there I was -- in the real world, eating and laughing with friends. Usually, we know what we need to know when it’s too late, when the experience is over.

By the way, Memorial Sloan-Kettering, where Pogrebin was treated, is the place where Israeli poet Abba Kovner died of throat cancer (in 1987), as well as the title of his final book of poems, in which he wrote, with great prescience, these humbling lines:

Soon

soon we shall know

if we have learned to accept that the stars

do not go out when we die. [Translated by Eddie Levenston]

Lisa Katz’s breast cancer poems made be found in Hebrew translation in her book "Shihzur," (Am Oved, 2008). "Late Beauty," a book of her translations (with Shahar Bram) of Tuvia Ruebner’s poetry, is forthcoming in 2014 from Zephyr Press.