1. Harpham, Wendy S. MD, FACP

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Your patients' children are calling you, even those too young to know you exist. With their world threatened by cancer, they need your help. For some of them (and the reason for this column), you may be the only person their Mom or Dad-your patient-will listen to when it comes to the healing power of telling children the truth.

WENDY S. HARPHAM, MD... - Click to enlarge in new windowWENDY S. HARPHAM, MD, FACP. WENDY S. HARPHAM, MD, FACP, is an internist, cancer survivor, and author. Her books include

My jaw clenches whenever I hear about seriously ill parents lying to their kids about what's happening. I keep picturing parents, stressed by their illness, striving to do the impossible: to hide from their children what can't be hidden and to act as if everything is perfectly normal. I keep thinking about some people I've known or heard about who, as kids, were lied to about their parent's illness and ever since have struggled with trusting others or have suffered from maladaptive responses to medical situations.


Patients today have easy access to expert parenting advice from superb books and pamphlets. A quick Google search for "Telling Children a Parent has Cancer" brings up articles on reputable websites, written by professionals (child life specialists, doctors, social workers). They offer insights and practical advice about what to say to children about almost everything, from alopecia to recurrence to end-of-life. Without exception, health care professionals urge parents to tell the truth.


Why Parents Lie

So what's going on with parents who keep lying, often going to great lengths to preserve their lies? For one thing, instincts to protect their children go into overdrive. Some patients feel obligated to preserve the innocence of childhood by shielding their children from the crisis. Or they assume their children cannot handle the truth.


For another, telling the truth hurts the parents. I found the pain of bone marrow biopsies more tolerable than that of witnessing my children's distress about my cancer.


There's the possibility that telling children the truth is too unsettling for patients who thrive using a hefty dose of denial ("I feel great! Everything will be fine!")-a coping style that can work fine if patients don't have kids.


Lastly, parents may feel unable to do it because they are too ill and/or distressed.


Let patients know that telling children the truth sets parents free. While in treatment, I didn't have to devise and keep track of lies, or worry about being found out. Mundane parenting tasks became more meaningful, joyful even, because telling the truth transformed hardships into opportunities to teach my children the skills and values I'd want to teach them if I'd never been sick.


Let patients know that telling children the truth empowers parents. Through my bond of trust with my children, I could comfort and support them through our changed reality. I could guide them to healthy ways of coping. Without doubt, the truth made me a better mother while I was sick and time felt short.


Even if you don't say it aloud, keep in mind that your patients' searches for truthful-yet-hopeful words for their children will likely lead them to healing insights and mantras for themselves. Teaching my children to accept the uncertainty, adjust to the losses, and move forward with hope, in fact, taught me how to do the same.


Let me stop here and state loud and clear: There is no absolutely right way to raise children through a parent's cancer. Parents must find what works best for their family-something only they can know. That said, the only way to know what's best is to have sound information. I repeat: You may be the only person who can convince some parents of the risks of lying to their children and the benefits of telling the truth.


Guiding Patients

To help parents make informed decisions:


* Acknowledge instincts: "Powerful instincts drive parents to try to protect their children from the crisis of cancer."


* Honor autonomy: "I feel confident you will find the best approach for your family. I will support your efforts."


* Urge informed decisions: "If you want to keep your cancer a secret, first learn about the risks of lying and the benefits of telling the truth."


* Offer expertise: "Studies show children benefit when told the truth, couched in love and support. In all medical circumstances, patients report that telling the truth made life better for their children and for them, even if it hurt when they did it."


* Justify delegating: "If telling the truth is too difficult right now, you are taking good care of your children by having someone else tell them."



Perhaps the most convincing argument for telling the truth comes out of the mouths of babes. From the time my three children were youngsters, they've insisted the one thing that helped them most was my telling the truth. They never had to guess what was going on or worry that we were hiding a problem. They believed nothing in the world was too scary or awful to talk about, no challenge too great to get through together.


It is now 25 years since my diagnosis. Telling the truth was essential to helping my children grow strong through my illness-and to helping me as a survivor.


Patients look to you for guidance. They listen to you. So ask patients, "What have you told your children?" Urge them to make informed decisions by learning about the risks of lying and the benefits of telling the truth. With hope, your patients will join the community of parents who believe the greatest gift we can give our children is not protection from the world, but the confidence and tools to cope and grow with all life has to offer.


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