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Home » The Vine

The Vine: July 24, 2013

Submitted by on July 24, 2013 – 8:32 AM25 Comments

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A friend of mine recently died of lung cancer, way too young (late 30s).

She wasn't a smoker (that I know of), and lived a very healthy lifestyle — vegetarian and lots of yoga. I find myself increasingly pissy and snippy when I tell people that she died and their first question is, "Did she smoke?" It seems to be a veiled "Is it her own fault?"

I admit that when I hear about other people having lung cancer, that's the first question that pops into my head, so I can't really fault people for asking — and yet I get more and more irritated every time. I mean, if someone has colon cancer, you don't say, "Well, did they eat enough fiber?" or thyroid cancer: "Did they get a lot of x-rays? Were they around Chernobyl at any time in the last 20 years?" Yeah, I know smoking's bad, blah blah blah, we all know, and we've kind of been trained to ask if a lung-cancer victim is a smoker, but 15% of lung cancer patients never were, and the rate of young non-smoking women getting lung cancer has been on the rise.

So I guess my question is, how do I answer these questions with going off on a rant (see above)? It just pisses me off, the implication that it might have been her own fault, AND this seems to be the only cancer where it's socially acceptable to be judgy about people's personal health habits. Sorry, there I go again. So what should I do? Smile tightly and say, "No"? Just say, "She had lung cancer, and she never smoked" to pre-empt it? Nobody really wants to ask that question and get a pissy educational lecture in return, right?

Thanks,
Rant rant rant

Dear Rant,

No, they don't. What they want is reassurance that whatever happened to her isn't going to happen to them. What they want is a way to put the information they've just received, that someone died from a terrible disease in her thirties for no real "reason," in a framework that controls it and puts it at a distance from them.

I'm so sorry about your friend, and it must be maddening to feel like there's a "well then she deserved it" lurking unspoken after every one of these questions — and sometimes, there may be, and that sucks. But I suspect that the majority of people just plain don't know what to say, first of all, and this is the closest remark to hand; it's sort of in the witless "at least she didn't suffer" brand of condolence remarks that are meant to fill air, and don't bear close examination.

Second of all…well, I recently rewatched the S3 Sopranos episodes when Junior gets the diagnosis of stomach cancer, and he does and says all these tactlessly nonsensical things — right, "more so than usual" — about the death of Bacala Sr. because he's convinced that "these things" come in threes, and if Bacala Sr. died from lung cancer and not from wrecking his car while coughing crazily from the lung cancer, then he's the third and Junior's cancer "turn" gets skipped. And Bobby Bacala is like, "You're skipping the funeral with this shit?" The parallel won't make sense if you haven't seen it, maybe, but tl;dr: the idea that a woman could just get lung cancer at that age, that this could happen, is terrifying to people, and their first instinct is to make sure that it's not going, or at least unlikely, to happen to them.

Having to inform them that no, it's just bad luck isn't any more welcome a duty for you than it is enjoyable for them to hear, but try to think of these queries in that way — it's not a judgment of your late friend. It's one of the many circles we draw around ourselves and our loved ones to try to keep the herd together as long as we can, even if we know it doesn't really work like that.

It's still painful for you, and that's okay, so I think your best bet is to move away from the subject quickly and gracefully. "She had cancer; I don't want to get into details, I'm sorry." "Lung cancer. …No, just bad luck, I'm afraid. Speaking of which, [news story]." Your instinct to defend your friend is sweet, but don't let it make you bitter; trying to see where dumb comments/snap judgments come from in these situations might help you feel less ranty.

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25 Comments »

  • Kari says:

    I'm so sorry for your loss, and it sucks that you're dealing with this particular aggravation now.

    I had a good friend die of lung cancer, also not a smoker (but older, in his 70s — aside from the lung cancer, healthy as a horse, very fit, etc.). My go-to response to the "Was he a smoker?" question was "No, he led a really healthy lifestyle. It was just really shitty luck." I embraced this kind of response because it let me tell the person a little bit about my friend, and also acknowledged the shitty randomness of his diagnosis. That was always enough to satisfy people re: the smoking thing. Although, I can imagine a true asshole who might push the issue after that, all "Well, he must have done SOMETHING to cause it" or whatever, and if someone had said something like that, I would have responded with appropriate vitriol. But really, very very few people are that awful.

    Again, I'm really sorry.

  • Sandman says:

    Sarah's right on the money here. I know how easy it is to hear an implied judgment in such questions, but the need to distance oneself from death, especially death that appears as random and unfair as a young woman's death from lung cancer, is a powerful urge. When my mother suffered a massive subarachnoid hemorrhage a decade or so ago, a number of her friends made remarks I found breathtakingly insensitive about how she always live a very high-pressure, Type-A life. (It was a congenital aneurysm.) I am sure no judgment was intended, but I felt it all the same. Believe me, I had a rant at the ready. It took me a long time to realize what they were doing was trying to put some distance between themselves and this incomprehensibly awful thing that happened to someone they knew and loved.

    Rant, I am sorry for the loss of your friend.

  • JC says:

    My condolences.

    I think another part of this is that smoking has been such a huge part of the health conversation for so long. I think all of those PSAs, education programs, etc., have tied lung cancer and emphysema almost exclusively to smoking, and vice versa, even though there's obviously not a 100% correlation either way. Just last week I experienced the opposite of what you did: I had someone tell me his aunt died of lung cancer, and before I could even offer condolences, he immediately said, "She was a smoker all her life." He wasn't saying it judgmentally, as he was very close to his aunt. I think he was just expressing sadness over what, in his aunt's case, was pretty clearly the cause of her illness and death.

  • Kate in Canada says:

    Rant – I am so sorry for the loss of your friend. It's tragic and shocking to lose someone we love at that age, no matter what the circumstances.

    I think Sars' advice here is spot on. More and more I'm hearing stories of friends of friends – young people dying of cancer never discovered until it was massively advanced, and then passing away and leaving a devastated spouse and children. Most of us want to believe that it could never happen to us and the urge to insulate ourselves from that reality is strong. I agree with Kari – I've seen it as an opportunity to share and grieve a shocking loss that came out of nowhere.

    Try not to let the bitterness take over – I have no doubt that 99% of people are not judging, but looking for some kind of answer that makes something totally senseless make sense.

  • Andrea says:

    A friend of mine recently broke the news of his lung cancer diagnosis to a group of us by simply calling it "non-smoker lung cancer". It doesn't really take any extra effort to describe it that way, and answers the question before it is posed.

  • Cij says:

    I think Sars is spot on with this one. Many hugs for you and all you are dealing with.

    It goes without saying, but Cancer Sucks.

  • DMCD says:

    Sars, you've hit the nail on the head with respect to people looking for reasons why they need not fear a similar fate. It's human nature. (I find myself doing it all the time. There's a fatal car wreck on highway 12? "OK…that won't happen to me," I irrationally reassure myself. "I never drive on highway 12.") We need that psychological insulation to get out of bed and go out into the world each day, with all its inherent injustices and dangers.

    I was actually in a serious car wreck in 13 years ago. I did nothing wrong – I was hit head on by a person in medical distress. The fact that I had no error of my own to point to almost made it worse, because of the complete randomness of it. If I couldn't have done anything to prevent it THEN, I know that I may not be able to prevent it NEXT TIME. It took 10 full years for me to feel comfortable in a car again, and the biggest reason for that was that my belief that this sort of thing would never happen to ME was stripped away, and I was left naked with the uncomfortable truth that yes indeed, it certainly could.

    This is touched on briefly in Gene Weingarten's stellar article in the Washington Post. Fata Distraction is about otherwise thoughtful, loving parents who leave their children to die in cars, and the harsh judgment that they receive from society. http://www.pulitzer.org/works/2010-Feature-Writing

  • Jen S 1.0 says:

    I'm so sorry for your loss.

    And yes, a great deal of the "cancer?" questions can be put in the "magical thinking/it won't happen to me" box. It doesn't make anything easier, but it helps people pretend things are easier.

  • Sarah D. Bunting says:

    Thanks, @DMCD — everyone else, I've read that article, and it's wonderful, but also very tough going and possibly trigger-y.

  • MizShrew says:

    Sars is exactly right — people have a tough time wrapping their heads around the random cruelty the universe can hand out sometimes. Smoking is part of the lung cancer "script," unfortunately, and people land on it without thinking.

    When my mom needed full-time skilled nursing care (severe dementia, Parkinson's, etc. etc.), a lot of people said things like, "oh, so she couldn't stay with one of the kids, then?" For a long time I read this as a judgement — that people thought we were just "chucking her in a home." The truth, I came to find, is that those who knew my mom (she was an incredibly sharp, smart lady in better years) simply could not picture her with dementia. Some told me point-blank that they found it hard to believe. They were not intending to be hurtful, they just were seeking cause and effect, or some kind of logic, and there simply wasn't any. Crappy genetics, maybe, but that's it.

    I'm so very sorry for your loss.

  • M says:

    DMCD, Thanks for linking to "Fatal Distraction. That article articulates the idea that people need concrete causes and sometimes monsters, when bad things happen, so we can pretend that bad things are completely avoidable, better than anything I've read.

    Rant, The grief and accompanying raw nerves due to the loss of a friend probably make it harder to give the clueless commenters the benefit of the doubt. Sars's script is a good one and I hope things get easier in time.

  • IsisUptown says:

    So sorry for your loss. An online friend of mine who was a Mormon (i.e., no she didn't smoke) died of lung cancer at a young age. Sometimes there are no simple answers.

    22 years ago, my sister was murdered. It was completely random – it wasn't by anyone she knew, she wasn't specifically targeted; she was just the next person out of that elevator, and her purse was upstairs in her motel room, so she couldn't hand it over to the man with the gun.

    It doesn't come up so much anymore, but right after it happened, and even later on, I'd get asked "Was she somewhere she wasn't supposed to be?" "Was she somewhere that wasn't safe?" Well, a person with a gun and bad intentions makes any place unsafe.

    So, people will ask stupid questions, because they want to know how to keep shit from happening to them. It sucks.

  • I wish that we human beings could all, as a species, make our peace with the fact that SHIT HAPPENS. Sometimes, even to people that we know. Sometimes, even to us.

    "Deserve" and "justice" and "karma" ain't got nothin' to do with it. Sometimes, shit just happens. And you can't stop it from happening to you next by blaming the victim like some kind of ritual scapegoat.

    I'm sorry for your loss, Rant. Even if your friend smoked 3 packs a day for the last decade, she wouldn't have deserved lung cancer, because no one (well, almost no one) deserves that. Our bodies all betray us in the end, even if we look after them carefully. Your friend got the short end of the statistical stick, and that that's a horrible thing to have happen.

    Also, you might want to point out to the people asking about your friend's habits that the vast majority of people who develop smoking-related lung cancer do so after the age of 50, after decades of smoking. Something like 10-20% of lung cancer deaths are unrelated to smoking, and the percentages get higher the younger the patient was at the time of diagnosis.

  • misspiggy says:

    Thank you for this question. I have a feeling I've asked this type of insensitive question in the past, and this is a good reminder to knock it off.

  • Meg says:

    As usual, yay, Sars, right on the spot.

    I've found the same strain of seeking-to-blame-the-victim with melanoma, diabetes, hypertension, and of course rape. The person asking why the victim suffered what they did isn't really trying to blame them (unless, you know, they are, in which case 1) no! and 2) let's all just be judgmental about people who don't use their turn signals or something like that), they're trying to reassure themselves that whatever this is can't happen to them because they won't make the same choices.

    We, as humans, try to rationalize everything. If we don't do x then y will never hurt us. This is understandable, but what we often forget is that we are applying specific situations to much larger problems with so many possible sources.

  • Sarah D. Bunting says:

    I've found the same strain of seeking-to-blame-the-victim with melanoma

    Yeah, me too. My friends living with HIV also report doofy follow-ups like "well how'dya get THAT?" Uh…maybe give that one another few minutes in the oven, moron.

    This sort of response is understandable, and normal, as I said. We all want to think that if we do life right, it won't bite back. But…you know. Try to stifle that shit until you get home. If details weren't already shared with you, confine yourself to "I'm so sorry. How are you doing with everything?"

  • ML says:

    I'm just so sorry to hear about you losing your friend. And I'm sorry that your friend had to leave you. I really wish you'd had more time together but it sounds like you both made the best of the time you did have.

    Both of my parents are now dead and I just turned 41. They were older than most parents and I've learned to appreciate all the time they did have here with everyone who loved them. I guess what I'm finding out is that I think people honeslty want to tell you that they're sorry for your loss, for the hurt you're feeling, but because they haven't lived your experience they just can't — not adequately, no matter how they try. And so they often get it wrong without necessarily meaning to say the wrong things. I try to remind myself that until someone has been through the pain and fear of watching someone they love die, they can't truly understand and the awful truth is that the only way they possibly could is to lose someone they love. I wouldn't wish that on anyone and so I work at focusing on the positives — recalling the good times with my parents, telling others about that sort of thing. I don't know if it's the right thing to do, but I try.

    So if people are going to ask "Did she smoke?" (which, I agree, is rather thoughtless and, frankly, not even the point — or their business either way), then I'd just say a quick "No" and let them know immediately how amazing she was — that she was vibrant and healthy and young and that our world is going to miss everything she had to offer but you and her friends and family will keep her spirit living with your memories and stories. That's how it sounds to me, anyway. My question to you would be "What was she like?" Because that's what I'd want to know. That's what matters.

    I didn't know your friend, but I'm sorry that we all lost her. We sure could all use a friend like you, though, to take our side in life or once we've passed on.

  • Rlnpirate says:

    My deepest sympathy for your recent loss.

    People are just so scared sh*tless by the word CANCER that they just don't know how to respond. My mother is going thru her 3rd round of colon cancer. Had she gone through the colonoscopy years ago as requested by her doctor, we may have avoided all this and she would be living her later years without this nonsense. I am so angry most of the time, not at anyone, but simply at the whole process that is cancer. When people ask about my mother, I have learned to channel the angry rant into a (I hope not too preachy) reminder to them to get their medical checkups regularly, pay attention to family history, have appropriate screenings done, yada, yada yada. I have it down to about a 15 second info-mercial-esque speech. I haven't lost any of my friends and a couple have even said, they scheduled tests they have been putting off. This little thing makes me feel like I can use the tragedy of my mom's illness to help someone avoid the "C" word. Maybe you could channel your anger into something similar. Sharing her story is a way to honor her memory, I'm thinking.

  • NCDevil says:

    "I'm sorry for your loss, Rant. Even if your friend smoked 3 packs a day for the last decade, she wouldn't have deserved lung cancer.."

    Thank you, The Other Katherine. No one deserves/earns/expects lung cancer. No one.

    I am so sorry for the loss of your friend, Rant, and that you're left in a tough spot with people's questions.

    My dad recently had a lobe of his lung removed due to suspected lung cancer. He somehow beat the odds (his mass was not a tumor at all, but a bizarre encapsulated infection). So many people — sweet, well-meaning people — asked me during that time if Dad was a smoker. And the truth is that Dad did smoke for 4-5 years. He quit 38 years ago, in 1975. Does that mean he deserved lung cancer in 2013? My grandpa smoked for 60 years, lived 10 years beyond that as a non-smoker, and died at 87 years old with nary a spot on his lungs. Even among smokers, it is a crap shoot who gets cancer and who doesn't. No one deserves it.

    And now when people ask if Dad had been a smoker, I ask politely, "Does it matter?" I think it's fair for you to say that your friend wasn't a smoker at all, but it would be so wonderful if we could gently teach people not to ask that question in the first place, for all the reasons outlined in previous comments.

  • Maria says:

    People just look for patterns to make sense of things. Lung cancer from smoking does make sense, young death from cancer does not. That's all.

    I think the real issue here is that you're grieving, and you want support for that. You don't want to invite judgment on your friend. I'm really sorry for your loss, and your desire to protect her memory from people carrying on like she did it to herself.

  • Maria says:

    That should have said, I feel for your desire to protect her memory.

  • Andie says:

    Rant, I am so sorry for your loss. I saw a similar pattern when a friend of mine was killed in a strange accident that was national news. My husband (who is a cognitive scientist) told me that our tendency to blame victims has been the subject of research for many years, and one of the best-known explanations is exactly what Sars and others have described: it is a way to protect ourselves psychologically.

    I'm a nerd, and I know this may sound silly, but learning about the Just World Hypothesis, which has 40 years of research behind it, really helped me deal with the unbelievably stupid and judgy things I was hearing and reading everywhere. Maybe you're a geek like me, and also find Science comforting? It doesn't excuse the behavior, but it does help explain it.

    http://tinyurl.com/wikijustworld

  • Megan says:

    but because they haven't lived your experience they just can't — not adequately, no matter how they try. And so they often get it wrong without necessarily meaning to say the wrong things.

    I do my best not to be actively rude, which mostly means keeping to the basics ('I am sorry for your pain.'). But after going through an extraordinarily rough year, I've found that my empathy is always very specific. I am now very good at babyloss, and can talk to other people in the same situation specificly and nicely. But if I knew what happened to your friend, I might accidently blurt out "Did she smoke?" like a thoughtless person who didn't learn anything from grief. Somehow it just doesn't generalize. I will only learn how to be compassionate about stuff like aging parents when I go through it, I'm afraid.

    Maybe after my next level of enlightenment, I will be better. In the meantime, I hope that I don't say anything more than I need to to express sympathy.

  • Phred says:

    Sincere condolences, Rant.

    My wife lost her 80-year-old mother to cancer earlier this year. "Lung cancer" got top billing on the death certificate, but it was really kind of a footrace between heart disease, leukemia, and a fast-acting lung cancer that first showed up in the chest x-ray the hospital took when evaluating her for a leukemia drug trial… I've had a couple of conversations with my FIL about this, and he's still a little irritated that the docs went with the lung cancer, since really it was the leukemia that depressed her immune system to the point that the lung cancer could gain a toehold. There is definitely more of a sense of judgement when people hear "lung cancer" than there is when they hear "leukemia".

  • pm says:

    This sort of thing can happen with accidents as well. I lost a friend last year to a tragic bike accident that was quite literally no one's fault. She was doing nothing wrong, nor was the driver who ran her over. She just had the terrible misfortune to fall right under the wheels of a car. It was purely accidental, and simply horrible timing. In the wake of her accident, I got so many questions and statements from people that were, at the time, enraging. Was she wearing a helmet? The driver must have been texting/speeding/drunk. Was she riding the wrong way/running a stop sign? Once I got some distance I realized that people were simply trying to distance themselves from the sudden, violent death of a vibrant 30-something woman, whether they were riders or drivers (we don't want to die, but we also don't want to cause someone's death going about our daily business).

    Condolences on your loss. Losing people we love is never, ever, easy.

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