This was the conversation I never wanted to have.
Just a few months ago, I got the news from my gastroenterologist: I had mantle cell lymphoma, a rare type of cancer affecting the lymphatic system. The news shocked me and my wife, and we needed a couple weeks to process it. The real challenge awaited us: how to explain the situation to our two young boys, who are 6 and 3.
We knew our 3-year-old would be too young to understand, so we decided to use the “waterfall approach”: We would focus on telling Alec, our 6-year-old, and then let him relate it in his own way to his little brother. In our family, a lot of information is passed along this way: We tell Alec, and he wants to be the one to tell his little brother. “That is what big brothers do,” he said.
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My first conversation was with Ms. Kelly, Alec’s first grade teacher. We felt it was very important that we both have the same messaging framework for Alec. If the two conflicted in any way, he could become confused, and we’d be at square one again.
As I took Ms. Kelly aside, I could see her face turn a pale grayish-blue. She expressed her sorrow to me, then reflected on Alec’s situation. “This can be devastating for a first-grader. It can negatively impact the rest of his school year,” she said.
Our sweet, young boy was doing wonderfully in school; the fact that my medical condition could hurt his school life made my heart sink. We talked about the various ways we could share my situation with Alec. What we settled on is a framework I believe all parents can use when they need to communicate a serious medical condition with their child.
After discussing it with my wife, we decided to tell Alec after school that Friday. The strategy we chose was one of familiarity. I had previously seen a dermatologist, who’d found a small squamous cell carcinoma on my left shoulder. The doctor removed a small flap of skin and sent me home with just a Band-Aid covering the area. This was helpful.
Before we sat down with Alec, I put my iPhone in airplane mode and opened the Voice Memos application. The reason I put my phone in airplane mode was to prevent an incoming call or text from stopping the recording.
I locked my phone and set it upside down on the counter right next to Alec. “Alec, do you remember when I went to the skin doctor and they had to cut off a little bit of skin on my arm?”
“Yes,” he said.
“That was a little bit of the early form of skin cancer. Do you know what cancer is?”
“No, what is it?”
“Cancer is when some cells in our bodies grow faster than others and our bodies can’t stop them from growing too fast. You know that our bodies are always growing, but did you know that sometimes there are areas of our body that can grow too fast and our body fights itself?”
“No, I didn’t.”
“It can happen, and when it does, we call it cancer. That is why they cut off those little bits of skin on my shoulder. They were growing too fast, and the doctor didn’t want my body to fight itself. Do you remember when your teacher said that she needed to get some skin cells cut off, too?”
“Yes,” he said. “She told us about that. We talked about it in class.”
“Well, I went to the doctor and they found some cancer underneath my left armpit. Do you want to see?”
He said OK — in fact, he seemed really interested — so I pulled up my sleeve and showed him my armpit. “Do you see anything there?”
“No,” he said.
This was what I was waiting for. I explained that sometimes cancer can be found underneath the skin. I explained to him that they had taken a picture of my body with an X-ray and found I had a little bit of cancer underneath the skin of my armpit. Rather than cut my skin open and take it out like they did with my shoulder, they were going to give me some medications to help it go away on its own. I continued explaining that the medicine would take about six months to get rid of the cancer, and we wouldn’t need any Band-Aids this time, because it was under the skin.
His face looked a bit concerned because we were using the “C” word, so we asked him how he felt. He told us that he felt partly scared and partly nervous. I asked him to come snuggle with me and comforted him by telling him that I was going to be OK. The medicine would probably make me a little tired and maybe a little cranky, too.
We snuggled there for a bit longer, talking about his feelings. We made sure that he felt OK with his feelings — reiterating that feelings are never wrong. Eventually he asked if he could go watch some television, and we said yes.
I opened my phone and stopped the recording. The recording was key because we knew his friends’ parents would will soon hear that “Alec’s dad has cancer.” We didn’t want to put the other parents in the same position of figuring out from scratch how to explain cancer to their children, so I sent each of them the audio from our conversation, asking them to listen to it. The objective was to provide them a framework from which to have a conversation with their own children.
Afterward, I received many thankful calls and texts from the other parents. They were happy to know how we had approached the topic, how we explained what cancer was, and how we used a real-world example to show how our family had already dealt with a type of cancer. Most important, they were glad to hear how we broached the subject of Alec’s feelings after having explained the situation to him.
Over the next couple days we received word that the other parents had talked to their kids — everyone was on a level playing field. Our approach paid off. Alec told his teacher and his friends about what he had heard, and it never went any further. We worked through it together, and there was no gossip at school or during play dates to create any additional worry for Alec.
It’s been two months since that conversation with Alec, and he continues to excel in school. His teacher has even made a point to tell us how wonderfully he’s been doing, praising his attitude and work ethic.
Richard Bagdonas is a proud father, husband, and philanthropist. Also, he writes.
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