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This is an odd node title because I read it two ways.

Grundoon writes as if the title means "What advice would you give a metastatic cancer patient?"

I read it as "How would you respond to someone who has metastatic cancer?"

And then I have multiple answers, depending on what hat I am wearing.

The doctor hat. The professional demeanor. Doctors are really trained to not break down in to tears, to not fall apart. It was not really discussed when I went through medical school and residency, so much as modeled. In second year medical school we dissected a cadaver, a real person, and you don't find out their name until the service at the end of the year. Ours was male. Sixty or older. He had cancer, metastases to his liver. Every cadaver was stored in an elevated coffin/vat of preservative. When we opened the vat, the body rose and dripped. When we took exams, the bodies were all up and the professors would stick pin labels in parts. What is this vessel, this organ, this nerve? We were used to our own cadaver and others would make our eyes run. We did not speak of the smell or how frightening it was. I am sure that we all thought about our person. Who was he? What did he believe? Was it the cancer that killed him or something else? Why was he generous enough to leave his body to teach us.

My second medical school rotation was pediatrics. And it was a horror show in a tertiary care hospital with children with cancer, children with rare liver and kidney diseases, children abused and neglected, or mysterious and tired of tests and blood draws.

I suppose I could go on and on. A counselor said to me recently that some patients are horrified by the doctor's disengaged calm when they deliver a cancer diagnosis. I delivered one last week and hugged my patient at the end and her daughter. I was so tired and worried and sad, but a little bit hopeful that it would be the treatable cancer by biopsy: we don't know yet.

The friend hat. Currently I can count at least 5 doctor families that have a cancer patient in the family. More. Gosh, isn't all this healing supposed to protect me from something? Store up pennies in heaven? It is not looking like it from here. And friends in the community and distant friends. It's the dance of intimacy. Really I do the same dance with each patient. What do they know? Are they a medical person? Do they want to talk about it? Are they confused about medical terminology or want to know why they were transferred to a hospital to cool their heels for 12 hours until the MRI was done? Do they just want to be silly and play and forget about it for a little while? And then I am part of that too, how much energy do I have left. I can run myself in to the ground and get sick. I think we each need time to rest, to play, perhaps whining is necessary and should be worked in, time to grieve, to be angry, and then, surprise, happy sometimes.

Don't try to hold on to it. Happiness. Laugh, cry, sigh and what will come next? For you or your friend.

I think that the most important thing is to stay present. A friend told me that when his friend was dying of kidney cancer, "Some people stopped coming around. They couldn't be with him. He was really hurt that people that he thought were good friends, stopped coming. But he was angry and sometimes it was hard to be around him." The friends get together each year, giving money to his childrens' college fund. Wouldn't it be easy to judge the person who wasn't there? But Rumi's poems say no. The poems say that people are where they are: the poem about the adult telling the embryo about mountains and fields and stars. The embryo says "I don't believe you. I only know what I have experienced." Rumi says that there are different stages in our lives and that we have to pay attention to the people we speak to, to have respect and knowledge of that stage. If I truly want to connect with my patient I have to listen very hard to who they are, what they know, what they are afraid of, what their questions are. I can't offer any healing unless I do make that connection. Unless they feel that I have listened and heard and answered. When we have both been present it heals me too.