We have two friends who are sick in different ways.

One had major surgery on his heart and is recovering; another has a malignant tumor he will soon undergo chemotherapy for.

We are close to both of them and try to contact them as often as possible and as often as possible.

They both have asked us to stay in touch.

Neither friend knows the other or knows anything about the other’s illness, and we are careful not to mention one to the other; they live far apart are both entitled to their privacy, and will remain faceless and nameless here.

We have different ideas for helping each one.

The first is someone who just had heart surgery and is eager for whatever information I can provide about my own experience. When I tell him how quickly I recovered, it is enormously helpful to him, he says. So I do it, even though I caution that everyone is different.

Every day, I am mindful of my rigorous hospice training and the lessons I learned about never making false promises to people, never promising them it will be okay, making sure the things I offer to do are possible and realistic and good for me to be doing.

These two friends have very different problems. I am quite familiar with heart surgery; I have heart disease and have had several surgeries and procedures.

The other has cancer, which I have had little experience with outside of my hospice and Mansion work and need to understand and respond to in a completely different way.

The truth is, there is not just one way to help, but many.

When talking to my friend who just had his heart surgery, I am willing to be upbeat and reassuring, since I recovered from the surgery myself and know it’s something that is done safely and successful a thousand times a day (at least) in America and has become almost routine here.

I know he wouldn’t be home if he wasn’t okay.

But I’m cautious about that. I’m not a doctor; I can’t say what might happen to him; I can only relate my own positive experience.

I know only one person in a thousand dies during open-heart surgery or as a result of it.

Cancer is a much more complex, diverse, and different thing.

In a sense, we are becoming a nation of helpers and caretakers, since our insurance pays for less and less all the time, government support for sick people is almost non-existent, and hospitals rush patients out as quickly as possible, and often before it is safe, due to the pressure of the insurance companies.

I was home writing and taking walks three days after my heart surgery, and I am no athlete or physical fitness nut. I find myself gently chiding my friend when he starts to feel sorry for himself or complains about the doctors not taking enough time to speak to him.

He responds to that.

(Is there any physician in the world who spends as much time with their patients as they would like after surgery? We both laugh when I ask that and laughing is important for him.) Heart surgery is common, but it is also painful and frightening.

Since I know and can tell he is getting better and will almost certainly be better (I know this from the way they are treating him), I speak to him in a way I wouldn’t to a hospice patient or my other friend whose illness is graver.

We joke about it.

I tell him he is lucky to be alive, that his wife and family might just as well be going to a funeral now as taking him to the cardiologist.

As men often do, he feels aggrieved at the idea that his heart failed him, and he and his wife keep wondering why there are bumps along the road to recovery, why it can’t all go smoothly all the time.

That is a perfectly normal thing to wonder.

Men who suffer depression after heart surgery are often uncomfortable speaking about it. Talking about that openly is perhaps the healthiest thing one can do. Talking with a heart surgery survivor brings him down to earth when he gets frightened.

My friend and I speak of this and laugh about it; he tells me how much our conversations are helping him see through to the other side. Still, I remind myself constantly that I am not responsible for his recovery, I am not his mother, I can’t make him healthy.

He knows that. So I can help him.

I think it isn’t until I learned the limits and boundaries of helping that I learned to actually be helpful. Maria and I talk about these boundaries all the time, as both of us have had problems giving too much when the people around us are in need.

Boundaries are therefore important to us. Our friends do not ask us to do more than we can or should do; they are self-sufficient and independent.

But we need to understand how we can help people without taking over their problems and taking them inside us.

I talk to my heart patient friend about gratitude or remembering how closes he came to dying.  When he needed me to, I reminded him of the miraculous surgeries that have saved the lives of both of us and given us years to live.

I forgive the surgeons for not being chatty; that really isn’t what they do. They save our hearts and our lives, which gives them a lot of leeway in my mind.

My heart patient friend is doing well now, wading through the health care, medical and emotional issues. He is beginning to return to his normal life, and we are having fewer and fewer of those conversations. Maria is close to his wife; I’ll leave her to write about her own experiences.

I think I helped. But the hard work was his and that of his wife.

When I talk to my other friends, it’s different.  I tend to go back to my hospice training. It is more formal and guarded.

Cancer is strange to me, alien. In my hospice work and my cancer work with therapy dogs, I learned not to cheer people up, assure them they will be fine or that everything might be okay.

I never suggest that they are fortunate, even though they might be, or that gratitude is an important thing to consider.

That would be both arrogant and inappropriate, not for me to say. They don’t need moral lessons from me. They need me to see them and be present.

Cancer quieted me in my hospice work, and now, I respect it and how it goes its own unpredictable way. My friend could be out riding his bike in a  few months or not.

This is where my hospice work was the most powerful and useful. It taught me about Active Listening. The best help I can offer is to listen, focus on what I am hearing, and make sure my friend knows that I can see him and listen to him.

Active Listening is different from Reflective Listening. According to Wikipedia, Active Listening is the technique of reading non-verbal cues, with feedback often in the form of paraphrasing, a technique widely used in counseling, training, and solving disputes and conflicts.

A good example is to watch the news from Washington when you can bear it. You will see that each side talks to and at the other, but neither actually listens to the other. Active Listening could help.

This, say psychologists is how most of us speak and listen to one another – poorly and partially.

We are not generally good listeners. In my hospice work, I learn that the only acceptable feedback for me was to repeat what I was told so the listener would understand that I was really paying attention and not just pretending.

This is very different from reflective or empathetic listening. Forbes Magazine lists 10 steps that help with Active Listening, much like my hospice training:

1, Face the speaker and look him or her in the eyes,  2. Be attentive, but be relaxed, comfortable, 3. Keep an open mind, 4. Listen to the words and try to picture what the speaker is saying 5. Don’t interrupt and don’t impose your solutions,  6. Wait for the other person to pause or ask clarifying questions, 7. Ask questions only to ensure understanding, not to argue, 8. Try to feel what the speaker is feeling, not just hear what they are saying, 9. Give the speaker regular feedback: “this must be difficult for you,”  10. Be conscious of what isn’t said -non-verbal cues like boredom or irritation.

My friend and I often make casual conversations without help. But sometimes, I will need to shift to Active Listening.

I don’t need to respond to him,  reassure him,  share stories with him, or make my friend any cheery and false promises.

I remember my hospice lessons. This is not my illness, not cancer or heart disease. It’s not for me to reassure people they will be getting better or worse. I must be humble and say I don’t know. I’m not God; I don’t need to be a savior, just a help.

Because I don’t know what will happen. Because that’s the truth. And once I lose my credibility, I will be of little help.

And if I tell a very sick friend the truth or acknowledge it, they will trust me enough to let me help them, mostly by listening while they talk honestly and openly to me, something they often can’t or won’t do among their families.

And yes, help with chores and groceries too.

I can’t take it in anybody else’s pain or feel their fear and hopelessness.

I can’t make promises to people.  I can’t save people. I can’t be exhausted or injure myself.

The role of the caretaker and the helper is to show up, to check in, to be available, but never intrusive or insistent.

I know to never say it’s time to move on or buck up or stop whining and give thanks for what you have. I know to never say you’re tough; you’ll get through it, you can make it.

That is humility for me, to understand that helping people is often as much about what I don’t do and say as it is about what I do and say.

It’s tempting in our culture to play Christ and step in with miracles, as people do in the movies, and to seize control of other people’s lives. That is not helping in my mind; that comes from what I need, not what they need.

And separating what I need and what they need is what helping people is really about. Be there, but not too close. Be present but not intrusive. Help, but don’t take over. Feel, but don’t absorb the pain.

Say no when it is in your interests to say no, say yes when you can, and be open and honest about both.

That is how I try to help.