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A doctor examines a mammogram in Los Angeles. Associated Press file photo

I was startled by a man's voice calling out my name in the doctors' parking lot. Turning toward it in the predawn light, I saw a physician-colleague fast approaching me, a wide-eyed look on his face. "Oh, my God!" he stammered. And before I could manage a response he blurted out, "I thought you'd be dead by now!"

It was my first day back to work after a long medical leave for cancer treatment. Having spent a year at home recovering in relative solitude, I was anxious about returning to my frenzied clinic job.

Mainly, I was dreading the prospect of becoming emotionally depleted through dozens of encounters with welcoming co-workers and patients. For, one by one, responding to their questions and concerns about my health, I would have to revisit my cancer. I would have to retell a story that still felt raw, deciding each time what information to share and responding authentically to whatever emotions arose. Throughout it all, I'd also have to address my patients' health care needs.

Foremost, I worried about the awkward "first conversations" I'd come to expect since having cancer. People struggling for "the right words" to say. Others crying or needing reassurance. Some insistently asking how I "really, really" felt and giving me a characteristic look that brimmed with doubt and sympathy, if I didn't sound sufficiently sad or fearful.


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My colleague's blunt remark certainly knocked the wind out of me. But, in an odd way, it also helped me feel more confident about the rest of the day, expecting no possible worse conversation-opener could lie in store for me.

Still, I would have preferred a gentler, more related way of greeting me. And as it turned out, he felt similarly, telling me years later that he'd always regretted his awkward comments.

The negative side effects of awkward conversation are well-known within the cancer community. And they can be as devastating as a round of chemo.

Throughout my career, many of my patients with potentially life-limiting conditions like cancer have described such side effects. And I've planned to write a book, based upon their real-world insights, that might help some of us become more comfortable -- and comforting -- communicators.

But I abandoned my plan last week after coming across just such a book: "When Your Life is Touched by Cancer -- Practical Advice and Insights for Patients, Professionals and Those Who Care." Written by Bob Riter and published this month by Hunter House, the book sets out to help people touched by cancer "have sometimes difficult conversations with their loved ones, friends, and health professionals."

The writing distills the author's personal experiences as a cancer survivor who, as the director of a cancer resource center, has also listened to hundreds of other survivors tell their stories. The book is stripped bare of thudding statistics and academic jargon, situating us in the realm of everyday language where most of us actually live. And it captures the reality of a complex and varied illness experience with compassionate good humor.

For example, Riter describes his own discomfort with "the look" he often received while undergoing cancer treatment. People would gaze at him "with solemn expressions and tilted heads as if they were looking deep into my soul. That look was always unsettling, especially when I was trying to eat lunch."

But Riter then proceeds to tell us about other cancer patients who were comforted by "the look," interpreting it as a show of concern. One woman said it was preferable to "the non-look" of people who avoided eye contact and conversation with her. Through such real-life examples, Riter reminds us that each person experiences cancer as a unique individual, and no rigid communication rules can ever universally apply.

Still, Riter observes that most people do feel awkward when first talking to someone with cancer, and though well-meaning "many say things that hurt or mystify more than they comfort." For them he offers communication tips based upon his extensive experience, hoping to reduce potential side effects from awkward conversations. For example, suggestions about "what not to say" include frequently voiced yet disconnecting comments like: "Don't worry, you'll be fine," and, "That's too bad about your cancer, but I could be hit by a bus tomorrow."

Riter is also wary about "positive thinking" zealotry, if even well-intentioned. People are too often "beaten over the head" with exhortations to "be positive!" which leaves them feeling blamed or responsible for their cancer.

And yet, in the end, when it comes to staying connected and supportive, Riter reminds us that "What's in your heart is far more important than what you say or the expression on your face."

That means showing up for your friends or loved ones, remembering they're the same people they were before their cancers, and staying the course of the relationship you shared.

A strange legacy surrounds our communication norms regarding cancer. Within living history, cancer diagnoses were often not communicated to patients for fear of distressing them. Families avoided talking about a loved one's cancer. Even the word "cancer" was often unspoken, conveyed instead through euphemism or coded as "the big C."

For all these reasons, books like Riter's are refreshing and significant. They urge us into fearless communication and heartfelt connection with one another when that may be most needed.

Kate Scannell is a Bay Area physician and the author of "Death of the Good Doctor."