"A closed mouth gathers no feet."

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For a Sick Friend: First, Do No Harm
Conversing with the ill can be awkward, but keeping a few simple commandments makes a huge difference.

'A closed mouth gathers no feet." It's a charming axiom, but silence isn't always an option when we're dealing with a friend who's sick or in despair. The natural human reaction is to feel awkward and upset in the face of illness, but unless we control those feelings and come up with an appropriate response, there's a good chance that we'll blurt out some cringe-worthy cliché, craven remark or blunt question that, in retrospect, we'll regret.

Take this real-life exchange. If ever the tone deaf needed a poster child, Fred is their man.

"How'd it go?" he asked his friend, Pete, who'd just had cancer surgery.

"Great!" said Pete. "They got it all."

"Really?" said Fred. "How do they know?"

A few simple commandments makes a huge difference when conversing with the ill.

Later, when Pete told him how demoralizing his remark had been, Fred's excuse was, "I was nervous. I just said what popped into my head."

We're all nervous around illness and mortality, but whatever pops into our heads should not necessarily plop out of our mouths. Yet, in my own experience as a breast-cancer patient, and for many of the people I have interviewed, friends do make hurtful remarks. Marion Fontana, who was diagnosed with breast cancer eight years after her husband, a New York City firefighter, died in the collapse of the World Trade Center, was told that she must have really bad karma to attract so much bad luck. In another case, upon hearing a man's leukemia diagnosis, his friend shrieked, "Wow! A girl in my office just died of that!"

You can't make this stuff up.

If we're not unwittingly insulting our sick friends, we're spouting clichés like "Everything happens for a reason." Though our intent is to comfort the patient, we also say such things to comfort ourselves and tamp down our own feelings of vulnerability. From now on, rather than sound like a Hallmark card, you might want to heed the following 10 Commandments for Conversing With a Sick Friend.

1. Rejoice at their good news. Don't minimize their bad news. A guy tells you that the doctors got it all, say "Hallelujah!" A man with advanced bladder cancer says that he's taking his kids to Disneyland next summer, don't bite your lip and mutter, "We'll see." Tell him it's a great idea. (What harm can it do?) Which doesn't mean that you should slap a happy face on a friend's grim diagnosis by saying something like, "Don't worry! Nowadays breast cancer is like having a cold!"

The best response in any encounter with a sick friend is to say, "Tell me what I can do to make things easier for you—I really want to help."

2. Treat your sick friends as you always did—but never forget their changed circumstance. However contradictory that may sound, I promise you can learn to live within the paradox if you keep your friend's illness and its constraints in mind but don't treat them as if their illness is who they are. Speak to them as you always did (tease them, kid around with them, get mad at them) but indulge their occasional blue moods or hissy-fits. Most important, start conversations about other things (sports, politics, food, movies) as soon as possible and you'll help speed their journey from the morass of illness to the miracle of the ordinary.

3. Avoid self-referential comments. A friend with a hacking cough doesn't need to hear, "You think that's bad? I had double pneumonia." Don't tell someone with brain cancer that you know how painful it must be because you get migraines. Don't complain about your colicky baby to the mother of a child with spina bifida. I'm not saying sick people have lost their capacity to empathize with others, just that solipsism is unhelpful and rude. The truest thing you can say to a sick or suffering friend is, "I can only try to imagine what you're going through."

4. Don't assume, verify. Several friends of Michele, a Canadian writer, reacted to her cancer diagnosis with, "Well, at least you caught it early, so you'll be all right!" In fact, she did not catch it early, and never said or hinted otherwise. So when someone said, "You caught it early," she thought, "No, I didn't, therefore I'm going to die." Repeat after me: "Assume nothing."

5. Get the facts straight before you open your mouth.Did your friend have a heart or liver transplant? Chemo or radiation? Don't just ask, "How are you?" Ask questions specific to your friend's health. "How's your rotator cuff these days?" "Did the blood test show Lyme disease?" "Are your new meds working?" If you need help remembering who has shingles and who has lupus, or the date of a friend's operation, enter a health note under the person's name in your contacts list or stick a Post-it by the phone and update the information as needed.

6. Help your sick friend feel useful. Zero in on one of their skills and lead to it. Assuming they're up to the task, ask a cybersmart patient to set up a Web page for you; ask a bridge or chess maven to give you pointers on the game; ask a retired teacher to guide your teenager through the college application process. In most cases, your request won't be seen as an imposition but a vote of confidence in your friend's talent and worth.

7. Don't infantilize the patient. Never speak to a grown-up the way you'd talk to a child. Objectionable sentences include, "How are we today, dearie?" "That's a good boy." "I bet you could swallow this teeny-tiny pill if you really tried." And the most wince-worthy, "Are we ready to go wee-wee?" Protect your friend's dignity at all costs.

8. Think twice before giving advice.Don't forward medical alerts, newspaper clippings or your Aunt Sadie's cure for gout. Your idea of a health bulletin that's useful or revelatory may mislead, upset, confuse or agitate your friend. Sick people have doctors to tell them what to do. Your job is simply to be their friend.

9. Let patients who are terminally ill set the conversational agenda.If they're unaware that they're dying, don't be the one to tell them. If they know they're at the end of life and want to talk about it, don't contradict or interrupt them; let them vent or weep or curse the Fates. Hand them a tissue and cry with them. If they want to confide their last wish, or trust you with a long-kept secret, thank them for the honor and listen hard. Someday you'll want to remember every word they say.

10. Don't pressure them to practice 'positive thinking.' The implication is that they caused their illness in the first place by negative thinking—by feeling discouraged, depressed or not having the "right attitude." Positive thinking can't cure Huntington's disease, ALS or inoperable brain cancer. Telling a terminal patient to keep up the fight isn't just futile, it's cruel. Insisting that they see the glass as half full may deny them the truth of what they know and the chance to tie up life's loose ends while there's still time. As one hospice patient put it, "All I want from my friends right now is the freedom to sulk and say goodbye."

Though most of us feel dis-eased around disease, colloquial English proffers a sparse vocabulary for the expression of embarrassment, fear, anxiety, grief or sorrow. These 10 commandments should help you relate to your sick friends with greater empathy, warmth and grace.
—Ms. Pogrebin is the author of 10 books and a founding editor of Ms. magazine. Her latest book is "How to Be a Friend to a Friend Who's Sick," from which this essay is adapted.