I could only imagine the anxiety Julia felt. It was high enough for her to call someone she hardly knew to ask for information. More than that, she called someone she hardly knew to ask for support. That part told me something about her without her telling me in words. I tucked the thought away as we sorted through all of the possible scenarios. I reviewed what the likely next steps were but Julia kept skipping ahead, her medical knowledge a detriment to her listening.

She hadn’t even had the ultrasound yet but had already thought about surgery: “I’d just as soon have a double mastectomy and not have to worry.” She imagined chemotherapy: “I can handle losing my hair.” I reminded her again and again that she was getting ahead of herself. Although doing so wasn’t unusual, it seemed to be fueling her anxiety. She admitted it was.


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But then she said what I have heard many patients say: “Of course it could be worse. I know that. My friend’s husband has advanced colon cancer. At least what they think I have isn’t as bad.”

In my interactions with patients and families, it isn’t unusual to hear someone say just that: “At least I don’t have it as bad as he does.” Or “My friend’s sister had such bad nausea she nearly died from it.” I used to nod when a patient made such a remark and tried to stay noncommittal. Yet by not speaking up, I felt like I was validating what they said only because I was uncertain of how to respond. If I said something, would it undermine their coping in a negative way? The last thing I want to do is get into a debate with a patient about how to handle his or her disease. I try to respect the patient’s coping, regardless of whether I agree with it. But I also think suggesting alternate strategies, without taking away the merit of the patient’s current coping mechanism, is important.

Kind of like a debate about weather: We take what is happening and make a comparison to what others have gone through. And seeing that someone else has it worse, oddly, can make us feel better, which isn’t bad. But the flip side is that this minimizes what you are going through. And minimizing the experience creates its own stress.

DISCUSSION

It took me a while to come up with a way to make my point about making comparisons in a way I felt was respectful and supportive. The communication challenge was to validate the person’s feeling but to nudge him or her toward a different way of looking at things. Interestingly, the idea of how to frame that came from thinking about the weather.

In Los Angeles, we don’t just compare our weather region by region; we also compare our weather to our close and famous neighbor community Palm Springs. You can be certain if the temperature in Los Angeles is 100°F and we are complaining about the heat, it will be a good 10 to 15 degrees hotter in Palm Springs. Many times during a heat wave, I have heard friends or neighbors say “Thank goodness I don’t live in Palm Springs.”

But the weather in Palm Springs does not change the weather where I live.