What to say to a 35-year-old mother dying of cancer

It is a near certainty that I will expire before my children finish primary school. In October 2012 I was diagnosed with advanced colon cancer, aged 34. Two operations and 12 cycles of chemotherapy later, I was declared cancer-free. A blissful three-month interlude of normal life concluded just before last Christmas, when I was told that the cancer was back, had spread aggressively and was now incurable. I’ll be shuffling off this mortal coil long before my allotted threescore years and 10, and probably before my twin sons hit six or seven, which I think is impossibly young and they think is impossibly old.

Mine is not a common story. Of the 40,000-odd people diagnosed with colon cancer every year, five per cent will be under 50. But recent US studies show that young people are more likely to be diagnosed when the disease is advanced, because no one (including well-meaning but negligent GPs) really thinks that cancer will strike before middle age; so young people can end up with even worse survival chances than the old.

In these, my last, luminescent months (or weeks, or years: who knows?) I am not fighting a campaign to change the NHS’s view of young cancer patients. I’m not climbing mountains to raise money for my local hospice or cancer research. The only selfies I post are ones where I am wearing a full face of very expensive make-up. Instead, I’m writing, as if it is the only thing which can stop the mutant cells from colonising my insides.

_{Kate with husband Billy in 2013}

Once upon a time, I was a lady who leaned in. I spent four years working in Downing Street before I was 30, serving two Prime Ministers. I founded and ran a charity which rebuilt the vital organs of state in post-conflict Africa; countries like Rwanda and Sierra Leone that were torn apart by war and are finally getting back on their feet.

But now I’m not leaning in any more, I’m reclining on my sofa and writing to my children. I’m writing the story of who I am and what I know from this period of my life, which is awful in the oldest sense of the word. And I write for you who are reading this, too, to give you advice on how to act with a family on the precipice of grief, what to say to someone who is going to die and what you can really do to help, because I have found there are few things more important and less spoken of than this situation my family finds itself in.

Since I was first diagnosed, we have been awash with love and offers of assistance. This intensified with the news that my cancer was terminal, but not straight away. No, in the first weeks after our news, there was silence from those outside our nearest and dearest. I don’t blame them; if it was me, I would maintain a respectful distance. I would wonder what on earth an outsider could do to help a family about to be torn apart. I would fear saying the wrong thing, being a blundering idiot.

But the truth is that it is always, always better to say something rather than nothing. We aren’t looking for words of great wisdom or succour. What matters is people acknowledge that this is happening, and show their willingness to walk this road with us.

Personally, my view is that it is better in a letter (you can have that one gratis, Royal Mail), because words can be savoured at any time and conversations can be exhausting. Whether hand written, texted or typed the best missives are short, full of love, news and come with a breezy “no need to reply”. At all costs, avoid the Facebook one-liner “Hi! How are you feeling?” The point is to divert me, not to polish your halo for having “been in touch”. Remember, my amusement bar is low. On a good day, you only have to be more interesting than Relocation, Relocation. How hard can it be?

But what to say when you come to visit? Well, below is a lovely diagram which you may want to recall as you stand on the doorstep, perhaps with some trepidation, not knowing how you will react if I am bald, fearing our grief, wondering if this is the last time we’ll meet. I saw it first when I was recovering from a liver operation last year (part of my treatment, performed in the US because they could do it in one sitting rather than two) so, with thanks to the LA Times, here is my version of the snail-spiral, plated up for me by a dear friend.

_{Kate’s 'spiral’ plate (JOHN LAWRENCE)}

As you wait on the doorstep, take a moment to think about where you sit in our world. In the centre of the spiral is me, the person who is dying. In the next circle out is our little foursome of a family. Sort of in the same bracket, but sort of not, are our parents, brothers and sisters. Outside that, a handful of our dearest friends, godparents to our children, best men and women. Outside that – and this is a big, blurry, happy set of categories – are others whom I love, but who are one degree removed. Colleagues. Old friends from work, university or school. Aunts and uncles. Outside that comes people I know but I’m not properly in touch with: former housemates; friends’ other halves; my husband’s colleagues; an old boss; ex-boyfriends; school-gate mums. And so on, until you get to the world at large.

Where you sit in the spiral defines how you behave. The rule is simple: you provide support to those closer to the centre than you. And you expect support from those further out than you. So, to put it bluntly, you can only emotionally dump on people in circles further out than your own.

Personally, I’m not averse to being wept on (it makes me feel special and a bit saintly) but in general, save your tears. Of course you are sad that I am dying, but most of the time I just don’t need to hear you snuffle snottily that you are so devastated that I am going to leave my children motherless. Hold it together, and weep on someone further outside your circle. And think about what you can do – practically, emotionally or otherwise – to support someone closer to the epicentre. If not the patient, their partner, mother, children, best friend. This is a powerful and important rule and I suspect you will find it applicable to almost any family crisis you find yourself involved in, whether you are rocked by the blast yourself or just dazed by distant aftershocks.

Once you have steeled yourself not to cry, got over the threshold and said something to us, the real fun begins. Because actually, things haven’t changed. Life has to go on, and no family with small children can exist permanently in a bubble of pain, whether pre-emptive or actual. And we have chosen to angle our chairs towards the sunlight, following the words of Jane Hirshfield’s precious poem: “I moved my chair into the sun/ I sat in the sun/ The way hunger is moved when called fasting.”

So, as you sit in the sun with us we don’t need you to be different, to suddenly speak only of serious matters or hold our words in some precious reverence. We are not made of glass; in fact, this experience reveals our family has a nugget of pure, rough diamond at our core. And you are still the same friends and family we have always loved, and what we need are people who will go on loving us.

So invite us to your house for lunch. Come with us on holiday. Take us down the pub. Hang out with me and the kids after school. And for God’s sake, don’t stop telling us your happy news. Up the duff? Hurrah. New house? Boom! You can even rabbit on to me about your irritating jobs, children or husbands. I haven’t stopped being interested – in fact the day-to-day divertissements of life are more precious to me now as a window into the normality I miss so much.

^{Kate Gross on assignment in Africa}

Of course, there are also practical things you can do. But those will differ from family to family and you will have to work hard to find out what they are, to establish a rhythm of assistance which supports but doesn’t intrude. There is a wonderful book called What Can I do to Help? by Deborah Hutton, which I highly recommend.

The key is to ask what we need and if you are met with silence, make suggestions. And then ask again in six months’ time, because the chances are that that is the point at which everyone else will have stopped offering help and your support will be really needed. And if you still don’t get an answer? Well, maybe just do it. Managing all the help that is offered in a time of crisis is tiring. Sometimes I just want someone to sweep in uninvited and quietly do the ironing.

I have to finish by returning to our Postie and the correspondence he brings – what I have been calling our own Letters of Note in honour of Shaun Usher’s magnificent compendium. I said that we haven’t asked for wisdom or solace, but it has come anyway.

There have been letters which have taught us how to live with uncertainty, how to exist when the world you know has been ripped out from under your feet and may never form stable ground again. Here, the story of a Palestinian-Jordanian friend whose family are spread across a Middle East that is fracturing (all over again) as I write. Jordan. The West Bank. Gaza. Syria. Uncertainty, fear and loss as geopolitics as well as family politics. The stories from South Sudan – the world’s newest country – which has threatened to tear itself apart since Christmas. My friends’ dramatic escape from the capital, Juba, and the fact that only white and rich people got on the planes out. The millions of people forced to flee their homes in a country which was already at the very bottom of the heap.

The letter from my beautiful, blind, disabled, master-skiing, Schubert-Sonata-playing cousin which reminded me that though things don’t pan out as you planned, life can still be wonderful.

And finally, there are the letters from people who have lost parents themselves. These crack my shell and make me weep hot tears for my boys, and for these friends who are so whole, so loving and so alive.

I got a memorable one from a beautiful girl who recalls being faced with a well-meaning but blundering new stepmother: “I had to hide my confusion and laughter, it was like someone telling me that you could replace fire with wind. As far as I was aware, the position of biologically giving birth to me, nursing me and giving me my eyes, sense of humour and apple figure wasn’t up for grabs. No one could ever tell me they loved me like she did and no one ever really needed to again, because it was my grounding, my bedrock. Just because I wasn’t told it every hour again, didn’t mean I didn’t feel it encircle me.”

I have received many letters like these. Too many, I often think. While they fracture the brittle shell which is slowly growing over my raw sorrow, they tell me what I need to hear. They tell me that though I will be gone, I will never be gone from my family’s life, and that, of course, is all I really care about.

*Kate is currently writing a book and actively seeking publication. She blogs at kateelizabethgross.wordpress.com.

You can contact Kate by emailing weekend@telegraph.co.uk.