Illness is a test of true friendship and many of us are not very good at it

GIVE you the shirt off her back, she would, no bother.

She wouldn’t be the kind to force a shirt on you if you didn’t need it, but should you find yourself shirtless, she’s the friend you want. Reciprocity doesn’t apply. She won’t want anything in return. Not only will you gain a shirt, but she’ll convince you that wearing it in some way does her a favour. She’s just plain good at friendship and just plain bad at making negative judgements of others.

All of which goes some way to explaining why she was floored when, having been diagnosed with breast cancer three years ago, a close pal, after a phonecall sharing the diagnosis, went AWOL, in communications terms. She never phoned or texted or emailed or asked how her friend was doing, even though the two of them often found themselves in the same room at the same time. Nada. Not a dickie bird of curiosity or concern. The incurious “pal” (and those inverted commas are more than usually relevant) caused the patient to wonder how many other people in her situation have experienced “such wild extremes of fealty and neglect”.

It might have ended there, except that the behaviour of her “good” friends was — in some cases — so helpfully overbearing that she came close to yelling at them that she was grateful to them for caring, but would they please leave her the hell alone?

Because she’s a writer, she decided to make something of her time in oncology waiting rooms by asking other people undergoing treatment for variants on the same illness how useful/absent/helpful/irritating their friends were. Thick and fast, they came, the accounts of abandonment or rotten communications.

When one man cheerfully informed a friend that the surgeons had got all the cancer with which he was afflicted, the friend didn’t clap him on the back and do a fist-in-air celebration. Instead, the friend wanted to know how the surgeons could be so sure, and when told this wasn’t helpful, claimed to have been nervous and to have said whatever came first into his head.

Equally, if not more frustrating was the litany a woman who had a stroke in her 50s met with: “I can’t believe this happened to you. You exercised. You ate right. You were so energetic.” All of which made her miserable, reminding her of who she had once been, pre-stroke.

But even those responses go under the heading “marginally acceptable” when compared with what has to be the most offensive comment ever made to a woman who’d just had a mastectomy: “At least you’re already married.”

We wince at the thought that anyone could think such a thought, never mind give voice to it. We preen, secure in the unearned certainty that in the same situation, we would be as empathic and insightful as a good friend should be to a sick pal. Except that the breast cancer sufferer who began to research the area, Letty Cottin Pogrebin, found to the contrary. She came upon so many examples of at best gauche and at worst crude remarks made by the well to the sick that she decided to write a book about it (How To Be A Friend To A Friend Who’s Sick). But this was more than good copy. This was an advanced course in human behaviour.

“I learned that illness is friendship’s proving ground,” she says, “the uncharted territory where one’s actions may be the least sure-footed but also the most indelible; that illness tests old friendships, gives rise to new ones, changes the dynamics of a relationship, causes a shift in the power balance, a reversal of roles, and assorted weird behaviour; that in the presence of a sick friend, fragile folks can get unhinged and Type A personalities turn manic in order to compensate for their impotence; and hale fellows can become insufferably paternalistic, and shy people suddenly wax sanctimonious.”

ANYONE who’s had a bad accident or a major physical or mental illness will confirm that some friends they thought would be rocks turned out to be made of melting jelly when it came to supporting them, whereas some they’d never have considered as supportive came through, big time.

The man in my life tried to die on me some years back and had to have radical cancer surgery involving the opening of his chest and removal of half his insides. For the first few weeks after the surgery, he could hardly move and spent most of his time sitting, stunned, in front of the fire. Which was where he was when the doorbell rang one afternoon and he found the late Alex Spain on the doorstep. Alex Spain had been managing partner of KPMG and was at the time chairman of a number of state and private companies. We knew him, but he’d never been in our house, nor we in his. He was also a man who mixed shyness with confrontation on a daily basis in no particular order.

On this day, as he refused tea or coffee and sat down, he thrust a plastic bag at Tom, who opened it to find three hardbacks, every one of them matched perfectly to his interests. Once he had thanked Alex, he found himself struggling for a good small talk question. Not one presented itself. The silence stretched beyond the normal. And then stretched further, into the comfortable. The two of them sat there in companionable wordlessness, watching the flames, and then Alex let himself out. It was completely satisfactory kindness from someone who was the most distant of friends. And it was characterised by many of the behaviours Letty Cottin Pogrebin lists as somewhat short in supply among pals visiting the sick.

In this case, the visitor left quickly, as opposed to exhausting the convalescent by the duration of his visit, and he left without offering advice. Far too many of us are willing to offer advice on treatments, orthodox and alternative, that should come from the patient’s doctor. Nor did he offer wildly optimistic predictions (“sure you’ll be out on the golf course by Thursday with a better swing than you ever had”) or verdicts on the patient’s appearance.

Much of what gets said to the seriously ill makes the visitor feel great, while leaving the patient in the slough of despond or spitting teeth with rage, neither state being markedly conducive to recovery.

It comes down to the patient’s individual needs. “Not all sick people want the same amount or kind of attention,” says Letty Cottin Pogrebin. “Women and men tend to ‘do’ friendship and illness differently. A joke amusing to one patient can be offensive to another. A squeeze of the hand can feel comforting when one friend does it, patronising when the hand belongs to someone else…”

What she doesn’t say is that in every society with an ageing demographic, where “upskilling” for older people is often taken to mean coming to terms with Twitter, a much higher priority is learning to be a friend to a friend who’s sick. Because anyone over 50 is going to face considerable demand in that area.