B is for Breaking the News

It’s May 2001. There’s a freak tropical storm gaining in speed and power. People are pacing, rain is lashing, and Dire Straits are strumming the opening bars of Brothers in Arms. This is the ‘West Wing’, Season 2 finale, where the President is revealing to the nation that he has been diagnosed with Multiple Sclerosis. This is a job for a professional heavyweight. This is a job for White House Press Secretary CJ Cregg…

There’s absolutely no good way to tell people that you have cancer. Nor is there, to my knowledge, a handy etiquette guide. But in the digital age the newly diagnosed cancer patient must swiftly become their own self-elected Press Secretary, lest they start receiving notes of condolence from the kid they think they remember from primary school before they’ve had time to pick up the phone and tell their gran. The friend sees the colleague, who emails the mutual acquaintance, who posts the question on facebook, and before you know it your newfound cancer status is spreading exactly like wildfire; just when you think you might have got it under control a little piece of ash sets off a whole new blaze of discussion somewhere you hadn’t even thought about yet. As any self-respecting fan of political TV drama knows, this is not how you manage the news cycle. You need to ‘own the story’ and owning the story means retaining some semblance of chaotic control over what the story is, who needs to know, how they’re going to hear it, and when they’re going to find out. Because not only is this deeply personal, it’s also the only thing you might get to control for a little while. More than that, you also want to protect the people you care about and spare them some of the emotional rollercoaster by managing it as well as you can. And, let’s be honest, you’ll take any opportunity to emulate your fictional heroes. You’ve been lumbered with the crisis, so you might as well pop on a power dress and channel your inner Washington wonder-woman.

The report of my death was an exaggeration

– Mark Twain

Unless you’re particularly high-profile you will probably conclude that you can’t justify a Press Conference where you finally get to utter the immortal words “and now, the President of the United States”, but that’s no reason not to approach the job with a professional mindset. You need a multi-channel Communications Strategy which proactively manages the full strengths and shortcomings of modern media:

1) Face to Face

High risk. Requires composure, brevity, and impeccable timing, all of which may be challenging to achieve. Reactions could range anywhere from uncontrollable snot and sobbing through to agonising awkwardness for all parties involved (particularly if you select this option to discuss the relative health of your breasts with any middle aged man in the office).

2) Phone

Unpredictable. Retains the personal touch, with the advantage that you will not have to witness the fear and sorrow in the whites of their eyes, but comes with the added complexity that the person on the other end may be at work/in Waitrose/trying to serve beans on toast to 3 screaming kids and a dog. Do not even attempt without preparing your side of the script.

3) Text

Approach with care. Instant, informal, and a good choice for nearest and dearest with whom you are in daily contact, but beware text speak and character limits. Save for evenings and weekends lest it pops onto the recipient’s screen mid board meeting.

4) Email

Woefully overused and abused, these are really the letters of our age, and we can all benefit from rediscovering the lost art of letter writing. Combines the personal touch with additional scope for long and thoughtful explanations. Requires proficient use of the address book, unless you want your heartfelt confession to end up with the plumber.

5) Social media

Cryptic attention-seeking status updates are unacceptable. Just don’t.

6) Trusted spokesperson

Essential, especially for spreading the word to acquaintances and colleagues. Carefully select and brief your team, and then let them help by doing some of the news-bearing for you.

Just as there is no Debrett’s guide for breaking the news, there certainly is no guide for how to receive it. Almost anything you say will be exactly right, providing it’s not: “Good. I can’t think of anyone more deserving”, or “How long have you got?” Ultimately the diagnosis comms are like a particularly awkward first date – tense, nervewracking, and unpredictable. It’s the guy who opens by telling you how much he likes keeping ferrets, which really wasn’t the revelation you were expecting from this particular night out, and you’re painfully conscious that you don’t want the horror in your heart to be visible on your face because OMFG this person has just told you that they KEEP FERRETS, but then maybe it’s not as horrifically bad as it sounds, and you like him enough to be sympathetic about his affliction and keen to understand more. In other words, we all just have to push on through and acknowledge that this is the absolute opposite of any conversation we ever expected or wanted to be having with each other, but soon it will be over (Please God is it over yet?) and, after this, normal(ish) service will be resumed.

Lord, I never wanted a double vodka at 9am before this week

– CJ Cregg, The West Wing

However, your initial announcement is just the start of this season’s story arc, and like it or not, most conversations you have will now require some form of health update. This is a long-term gig, and like any new job you will make ill-judged, rookie mistakes in the early days, but as diagnosis transitions to treatment and recovery you will grow in confidence and capability. And whilst you’ve been on the crash course in cancer medicine, you must remember that your audience has not, so whatever the latest development or question you will need to be forearmed with your official statement, consistently informing, educating and setting the tone – and shooting for broadsheet balance rather than tabloid sensation.

The Case for Full and Frank Disclosure

It goes without saying that one thing you have to get very comfortable with very quickly is everyone knowing a lot more than they did about your body, which isn’t altogether easy. My own experience has led me to conclude that part of the reason Britain lags behind the best of Europe on cancer outcomes is our national character – our famous “don’t mention the cancer” stiff upper lip mentality. And here – finally – Debrett’s can shed some light. British Reserve – a ‘disinclination to show emotion’, and ‘widespread refusal to make a drama out of a crisis’ – is cited as the reason why people experiencing symptoms of heart attacks wait an average of 90 minutes before calling the emergency services^[1]. I can identify with that. I was the very definition of savvy and aware, but when the time came for me to actually approach a doctor I found the whole process a bit embarrassing. I didn’t want to say to my GP “I think I have a lump in my, ahem, breast”. I didn’t want to talk about my “breast” at all. Nor indeed did I want to lie on a surgical couch having it prodded and poked by a woman I barely know. Frankly, if I’m going to lie on a bed having my décolletage explored at all, I’d rather it was by a handsome bachelor under significantly more passionate and candlelit circumstances.

Maybe it’s just me. Maybe I’m a prude. But I don’t think I’m alone. I don’t think we Brits generally want to talk about our intimate parts, and we certainly don’t want them interfered with by the medical profession. That’s perhaps part of the reason why uptake rates for bowel cancer screening in the UK languish at an average of 58%^[2] , which means there is a simple screening test being sent to everyone at the highest risk of bowel cancer, and almost half of the people who receive it aren’t using it. (That’s half of all our parents or grandparents by the way). And perhaps inhibition also has a little to do with the fact that 1 in 3 women under 35 are not attending smear tests^[3], despite cervical cancer being the most common form of cancer for women in that age group. Quite aside from the woeful waste of scarce NHS cash this represents, to the person on the other side of the diagnosis, this is insanity in action.

Our quaint British reserve is giving cancer a free ride. Not only does it prevent people being proactive about their health, but for the person living through cancer it can create an unnecessary and irrational sense of embarrassment and shame. I’m not ok with that. I’m not ok with anything that heightens cancer’s power, which is why I opted for a ‘full disclosure’ communications strategy. This is not a situation for spin. We all need to talk more about breasts and balls and bums and bits. We need to stop being so blushing British and get absolutely familiar with ourselves and all the signs that something might not be quite right. And we need to teach our teenagers – as well as our parents, apparently – to make sure they grow up totally comfortable with what to check for and why, without feeling any embarrassment or reticence at all. Because I guarantee that the inconvenience of the occasional boob grope or bottom check is absolutely nothing compared to the indignities you face if you actually get a serious illness and overnight find yourself wandering around in a permanent state of undress, flashing your intimate parts at literally anyone who offers to examine them, and starting every conversation with a brief history of the latest developments beneath your underwear. For the professional Patient and part-time Press Secretary, that’s all in a day’s work.

10 ‘Red Flags’ we should never ignore^[4]:

Unusual lump or swelling
Unexplained bleeding
Change in bladder habits
New bowel routines
Unexplained weight loss
Unexplained pain or ache
Persistent cough
Difficulty swallowing
Sores that don’t heal
New mole or changes to a mole

Links

Coppafeel run by the inspirational Kris Hallenga delivers breast cancer awareness in universities and schools. Join or support the Boobettes at http://coppafeel.org/

Cancer symptoms: http://www.cancerresearchuk.org/about-cancer/cancer-symptoms

Talking about cancer: http://www.macmillan.org.uk/information-and-support/coping/talking-about-cancer/if-someone-has-cancer