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Part 1

Karen’s lung cancer was a bolt from the blue. She had never smoked, had no family history and was simply unlucky. Dr Ranjana Srivastava shares her patient’s experience of talking to her children about her diagnosis. Karen wanted to tell the children and overcame her husband Jim’s early hesitation.

*Adapted with permission from “How do you tell your children you have cancer?”, The Guardian, November 2015.

She sat them down one evening and told them that she had been diagnosed with an illness called lung cancer. She deliberately chose to use the correct terminology rather than Jim’s suggestion of calling it a lump. We had discussed the fact that children fell down in the playground and got lumps and bumps. She didn’t want the children to think that all lumps were sinister. Their eldest, Alyssa, had seen the ads depicting cancer on cigarette packets and her first question was if her mother had been smoking cigarettes. Karen assured her daughter that she had never smoked and that sometimes people developed cancer for unknown reasons. Robbie, their middle son, wanted to know if she was going to die. He had a classmate who had just lost her grandfather to lung cancer. “I’m not dying right now, darling,” Karen told him. “I hope to get better with treatment.” The youngest child, Emily, at four years old, didn’t understand any of the conversation. She jumped on her mother’s back and chirped: “Can we play hide-and-seek now?”

As she began chemotherapy, Karen set about consolidating a support system for the children. She did this by calling upon a small group of parents whose children were friendly with hers. Over the next few weeks, they worked out a system that meant each child had one or two additional adults to rely on if Jim and Karen were both busy. When Karen felt well, which was almost always in the initial months, the extra help was not needed, but having a roster in place meant that the other adults were not surprised at being rung at short notice.

A practical thing Karen discussed early with her children was rearranging after-school activities that required prolonged parental involvement. She explained to the children that while she was keen to maintain their activities, her illness meant that they all had to make adjustments. For Alyssa this meant finding a French class closer to home. For Emily it meant moving a gymnastics class. Robbie offered to reduce the frequency of his painting lessons.

Karen spoke to her children’s school early in the piece, too, letting them know about her diagnosis and the changes in their lives. The counsellor agreed to keep a close eye on all three and periodically provide updates to Karen and Jim.

One day Robbie came home, upset that a boy in his class had said he would catch cancer from his mum. On hearing this, Alyssa complained that she was sick of being asked if she was all right. Little Emily, meanwhile, carried on, seemingly oblivious to anything being out of the ordinary. Karen used the occasion to discuss her cancer with them further. She reassured Robbie that cancer was not contagious and explained to Alyssa how much her friends and their parents cared about her. Karen also told them that her being sick was not the children’s fault and that people sometimes said awkward things because they didn’t know how to express their true feelings. Karen felt that this gave the children permission to discuss any other concerns they might have about her and bring home any comments they had heard on the playground.

Part 2

Things went smoothly for nearly nine months and everyone fell into a comfortable pattern. One day, Karen came in for a quick visit with all three children, whom she left in the waiting room to watch TV. Dr Srivastava won’t forget that day, because it was when she had to tell Karen that after more than a year of stability, the cancer had begun to spread.

 *Adapted with permission from “How do you tell your children you have cancer?”, The Guardian, November 2015.

We talked about changing treatments and hoping for the best while expecting that treatments down the line would not work as well as the initial one. She listened worriedly and then burst into tears. “Oh, what a bad day to bring the kids,” she said in a woeful understatement. Then I watched in admiration as she rose and washed her face in the sink, reapplied her lipstick, and said: “We will handle it. I will talk to them.

Some weeks later, when we met again, I reluctantly asked how her talk had gone with her children. She said that directly after her consultation, she took them out for ice cream and enjoyed the occasion while suspending her fears. Later, with Jim present, she told the family that the cancer was becoming active again. Karen talked seriously but kindly and slowly, telling the children that she wanted them to know the truth from her rather than hear snatches of conversations elsewhere that left them wondering what was going on. She told them that she would always be honest with them. This is when Alyssa asked if her mother was going to die.

“I will probably die one day from this cancer, but the doctor says it’s not happening yet. So I plan to take the new treatment, and I promise to let you know if things are not working out.” Karen said that this was the question she had been most dreading, but tackling it honestly had been far easier than offering excuses. Robbie had always been deeply perceptive. “But Angie’s grandma died in her sleep. What if that happens to you?” To this she replied: “I suppose this could happen, but if I die in my sleep, you know that Daddy is healthy and perfectly able to look after you with the help of all our wonderful friends and family.” Karen said that since she could not reassure him about how or when she would die, she wanted to emphasise that they had a support structure in place that they had experienced and trusted. They would not be left alone.

As Karen began her new treatment, the children again settled into their routine and accepted a slightly different normality. Although it’s easy to relate Karen’s experiences here, I found it heart-wrenching to hear her accounts at the time. It seemed unfair that anyone, especially innocent children, should have to go through such grieving.

But when I brought this up with Karen, she said with typical perspective: “Doctor, it is what it is. I just want to prepare them for life without me and know that I have done my very best.”

The next big change came when she became very breathless and had to be hospitalised. Emily visited her in hospital but her older children decided to wait for her at home. Karen sent them a message but didn’t insist on their coming in, believing this was their way of coping and perhaps slowly coming to terms with her dying.

Soon after this, Karen was admitted to hospice. That evening the children visited her in hospice. Jim had explained where she was and what to expect. He told Emily that her mum was sick and was going to meet God. Robbie asked if it was going to be quick and Jim said the doctor expected it to be, but it would relieve Mum of more suffering because the cancer could not be cured.

Four days later, Karen became unconscious. She was sedated and looked peaceful. Jim was devastated but, true to Karen’s promise, kept the children involved till the end. One after the other, they all said goodbye to Karen.

This information was last reviewed in December 2018
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