1.    Sit with a friend through cancer treatments because you love her, not because you believe she would do the same for you. She won’t. Cancer changes people, and it makes people vulnerable. If your friend survives, she will want to reinvent herself. She will need to reinvent herself. What I mean is: your friendship is probably over, once your friend beats cancer. You will help them do that—survive—but your only reward is likely to be that knowledge. You may, later, go through cancer treatments yourself. It is possible that you will do this alone. Even if you sit with three different friends through cancer treatments. What is important to realize is that you helped them survive because you are good at survival.

2.    Your best doctor is your body. Hopefully you will also find other doctors who have more training in and experience with illness than your body does, but I would not count on it. Weigh professional opinions and theories against how a medication feels in your palm, or what comes to mind while it digests in your stomach. Avoid processes that allow the administration of treatment to get too far away from your own hand. Not because you should not trust other people—you should—but because it matters if you shake before you give yourself an injection, or if your heart aches every time you go in for new lab tests.

       Another way to say what I mean: notice what makes you feel bad, and avoid it in the future. I have found that most people do not know when they feel bad. I personally did not learn how to tell when I feel bad until I turned forty-four.

3.    Many people will offer advice. No—everyone, in some way or another, will offer advice. Some will tell you to change the way you eat, or how to feel. They may suggest you find a better doctor, as if you do not live daily with the failures of modern medicine. Others will tell you how you can make it easier for them to understand what you are going through, or demand that you be patient with them. You must try not to laugh. If people grow annoyed at your behavior, they may repeatedly ask what is wrong with you, even after you have told them one million times that you are sick. Still others will believe resolutely that you have done something wrong. They will say, “a-ha,” at the wrong time when you relay an anecdote, or forward articles to you about smoking, yoga, or drinking tap water. They do this out of kindness, but what is being said is: you are failing to live up to my expectations of you.

       If you bother to listen to other people at all—although I can understand why you would not—you may wish to translate everything anyone tells you into the phrase, “I care about you more than I myself realize, more than I am currently capable of expressing.” Do this without speaking, inside your own head. It is only for you.

4.    This is important: do not hate your disease. If you can, try not to hate anything at all, but that may be too hard. You have a right to be angry. Still, hate is for people who feel they have nothing to lose, for people who are comfortable sitting in judgment of others. Most important: hate takes time and energy. Time you could be devoting to far more important pursuits, like laughing at jokes, or research. Hate only inspires more hate; what you need right now is love.

5.    When someone discovers you are sick, do not be surprised by their cruelty. For example, someone may say, “Oh, my grandmother committed suicide when she was diagnosed with that!” Or an acquaintance might give you false information about your disease. This will happen, surprisingly frequently, with doctors. Friends in media and entertainment will write you into stories as a character, taking your hard-won experience of survival from you without permission and using it to advance their careers. You may see yourself become a morality tale for hard living, dangerous choices, sexual promiscuity, eating meat, lack of religion. You may find your high school best friend does this, or your auntie. It is what people do: use what they come across for their own purposes. You cannot blame them, but you do not have to be around them.

       Another acquaintance, after a frank conversation about your illness, may comment, “Wow. It’s terrifying that such a thing could so easily happen to me!” Laugh at that person. Laugh at their narcissism, at a worldview that believes that illness picks and chooses victims for a moral or ethical reason, or any reason at all. Laugh at the fact that they feel safe when you know that they are not. Hope that they remain safe, because an unjust comeuppance for narcissism is illness. But do not trust that person. Do not trust anyone who takes from you in your moment of greatest need.

6.    Others will avoid you. Most will avoid you. They do not want to deal with mortality, yours or their own, or what strikes them as worse than death: frailty, weakness, disability. This will make you deeply sad for the world, and for yourself, that you may never speak to your best friend again, to any of your best friends again. If you ran a company or organized events in your neighborhood, those people—whose lives you worked hard to support—may not gather around you. Let me tell you this because no one else will: people are awful. I am sorry that you will feel alone much of the time. I am sorry for every doctor’s appointment and bad-news phone call that you have to endure by yourself. I am sorry about the time that pharmacist was flirting with you until he looked at the drug you came in to pick up, and paled. I am sorry that an insurance agent once called you to demand $986 to pay for the test result that indicated a $1,200 per-injection drug prescribed by your doctor had given you a new disease. I am sorry for the bitch on the bus who couldn’t see you were in pain so complained loudly for three miles that you wouldn’t give up your handicap seat for her shopping bag. I am sorry that the energy you once spent making others laugh or dressing up for parties or planning elaborate adventures is now used to fill weekly pill containers, do tai chi, visit specialists, or trying to stay awake.

       I am sorry it seems so easy for others to forget you are important.

7.    Another way people might react to your illness is by saying quite effortlessly: “What can we do, your community?” It may take a year to hear this question, or longer. You may think you will never hear it. In truth, you might never hear it. You will expect to hear it when you post on Facebook about a negative test result or mention to a small group of friends over coffee that your doctor is concerned. The crucial question will not come then. It may not come when you fail to show up for birthday parties, although it is clear that your absence has been noted. It may not even come after a week when you cannot answer the phone, or when you do not have the energy to respond to emails. When you effectively disappear from the face of the earth.

       You will be made aware then that people are gossiping, but you will also be aware how few of those asking others about you have ever actually asked you how you are. Everyone will feel that they have expressed concern and wished you well, but the actual number of people who will do so is quite low. You may see, in other words, the evidence of community forming, but it will still take time for its benefits to be offered to you.

       Try not to sob when this happens. The friend who finally mouths these words will believe she is the hundredth person to say, “What can we do? How can the people who care about you show it?” Do not mention that you don’t know if you believe in community anymore, or which exact community members have hurt you beyond repair. Do not test her faith in the power of people to gather in support as yours has been tested. Just answer her question.

8.    Your European friends will make what seems to them to be very logical suggestions: request a paid leave from work, go to a health spa for a month, begin receiving disability compensation. Supplement your Western medical treatments with Chinese medicine. These treatments may not be affordable or in some cases available to you in any way. Your European friends will be baffled by the cruelty of the State. It will not make sense to them how a rich nation can so severely take advantage of its population. This is important: do not attempt to answer their follow-up questions, because a whole lifetime can be wasted describing the injustice you are currently experiencing. It does not need to be yours.

9.    Even if you have been assured the most basic of care by federal policy—however minimal indeed for those whose diseases are little understood in the first place, and for whom there are therefore no effective treatments—you may suddenly find yourself in your doctor’s exam room, crying over the threat of its repeal. You doctor may face personal threats from the same administration: perhaps she was born in a country from which others have been denied entry to the US by surprise executive order, or fears annulment of the law that allowed him to enter a same-sex marriage with his partner of several decades. Certainly your doctor faces a potential job loss. Your doctor may also cry. However it is possible that your doctor could say, “I have a plan.” Then your doctor may detail the black market prescription dispensaries, back-alley lab testing facilities, and unsanctioned exam rooms around the city that will allow you to survive. You may wonder if this is a movie, or a trap. The sliver of hope, however, will buoy you. Let it.

10.  You will learn to get by on very small kindnesses. These are often gifts so tiny they mean nothing to those who dole them out. A fruit basket sent by the secretary of a man you worked with once, whom you have never met in person. He is an acquaintance of a good friend that you never heard from, post-diagnosis. A heartfelt but single-line email from a colleague on the other side of the country; an extra warm hug from someone you respect but do not know very well; an angry email from someone in your same line of work, someone who rightly tells you to buck the fuck up when you have professed a desire to give up; someone who does not mind that you are sick, but cares enough to see past that, and spot that you are about to make an irreversible mistake. Over the course of a month, you may only experience one such event, or you may not experience any at all after several years. But if you do, and you thank these people later, they will not remember what they did. They will have no idea that they saved your sanity or your life, that collectively and without even trying, they have created a world you are desperate to stay in for just a little while longer, no matter how difficult.

11.  I’m going to be honest with you. I have no reason not to be. I do not know you, and we may never meet, but I can say without a doubt that your doctors may not be telling you the truth and your friends certainly aren’t. Drugstore clerks honestly do only want your money. RNs have plenty of other patients set to take your place. Your company can do without you just fine. Your pets will even move on. (I am not saying that people do not love you. They do.) Yet this moment of horrible honesty is required, so here it is: there is a chance that you will not make it through this, whatever “this” is for you. You may die soon; you will certainly die eventually.

       Peer at that statement. Ignore that it is sorrowful and unkind, even as you also admit that it is true. Take it as a reminder to care for what you love, and a plea to be courageous in defiance of unspeakable cruelty. If you do not make it through this—whether it is, this disease or this economy or this political regime or these very, very difficult days—let us remember you as someone who loved very deeply.

       Do not let us forget how much you cared.